THE IMPACT OF HYDRATION ON MANAGING ONCOLOGICAL PAIN IN PEDIATRIC PATIENTS ACROSS EUROPE

G. Fedelfranco¹, F. Germini² | ¹Social Health District ASL Bari, U.O. PUA/UVM (Single Access Door Operating Unit/Multidimensional Evaluation Unit), Bari; ²DSS n. 10 Director, ASL Bari

INTRODUCTION
Effective pain management is a fundamental component of pediatric oncology care, directly influencing quality of life, treatment adherence, and clinical outcomes. While pain control involves multifaceted strategies, hydration—particularly the selection and administration of intravenous fluids—has emerged as a potentially modifiable factor affecting both physiological and clinical dimensions of pain in pediatric cancer patients. This study examines the impact of hydration protocols on oncological pain management in pediatric patients across European healthcare settings.
METHODS
The search strategy for this scoping review was conducted on PubMed, Google Scholar, CINAHL, Scopus, Web of Science(WoS), PsycINFO, EBSCOHost databases using with keywords such as "hydration", "pain" and "pediatric oncology,". Following the sorting of articles by abstract and title, the screening process yielded a total of 48 articles. Based on full-text screening and relevance to the research questions, methodological rigor, geographical focus, quality of evidence, and clinical applicability, 10 articles were selected for inclusion in this scoping review. The analysis integrated available data on hydration protocols, pain management frameworks— including the WHO Analgesic Ladder—and organizational practices in European pediatric oncology settings. The studies examined the transition from hypotonic to isotonic fluid protocols and their effects on electrolyte balance, organ function, and pain-related complications.
RESULTS
The analysis revealed that isotonic fluid administration significantly reduced hospital-acquired hyponatremia incidence without causing hypernatremia in pediatric oncology patients. However, increased furosemide usage was observed to manage potential volume overload, leading to elevated potassium and bivalent cation levels, decreased acidosis risk, but increased alkalosis frequency. Acute kidney injury rates remained unchanged. Implementation of the WHO Analgesic Ladder in 84 pediatric patients demonstrated statistically significant pain intensity reduction over three weeks (p = 0.000). Organizational surveys across 77 PICUs in 12 European countries revealed that only 30% of centers implemented oncology-specific protocols including hydration management. Multidisciplinary collaboration was identified as crucial for addressing complex needs encompassing both pain and fluid management.
CONCLUSIONS
Evidence suggests that hydration practices—particularly the shift from hypotonic to isotonic fluids—have an indirect yet meaningful impact on oncological pain management in European pediatric populations. Although direct evidence linking hydration protocols to quantitative pain score reductions is limited, appropriate fluid management mitigates complications such as hyponatremia and supports physiological stability, thereby fostering conditions conducive to effective pain control. These benefits arise chiefly from the prevention of secondary complications that may intensify discomfort or hinder analgesic strategies.