Does Nebulized Lidocaine Reduce the Pain and Distress of Nasogastric Tube Insertion in Young Children? A Randomized, Double-Blind, Placebo-Controlled Trial

Babl, Franz E; Goldfinch, Christopher; Mandrawa, Christine; Crellin, Dianne; O’Sullivan, Ronan; Donath, Susan

doi:10.1542/peds.2008-1897

Cited by 41 publications

(33 citation statements)

References 29 publications

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“…In studies on younger children where scoring the multi-dimensional experience of 'procedural distress' using the FLACC scale has been attempted (Merkel et al, 1997), any observable distress is scored as pain. Unfamiliar, fear-inducing preparations for invasive interventions, for example holding the child in the lithotomy position during sterile cleaning prior to urethral catheterisation (Vaughan et al, 2005) or administering nebulised lidocaine prior to nasogastric tube insertion (Babl et al, 2009) are scored as 'moderate' pain.…”

Section: Discussionmentioning

confidence: 99%

Introducing LAPPS (Liverpool Anticipatory Procedural Pain Score)

Craske

Dooley

Griffiths

et al. 2013

J Child Health Care

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Removal of chest drains is a painful procedure and distresses patients, parents and nurses. To identify problems and improve management we developed a concerted approach to both assessment and treatment using audit. An initial prospective audit of post-op cardiac children undergoing chest drain +/- pacing wire removal was undertaken. A clinical tool was developed, to assess children before procedures and provide a treatment plan aimed at reducing pain and distress. The tool incorporated the intensity of the procedure, the child's usual response to procedures and previous experience. The treatment protocol included drug and non-drug therapies. The initial audit of 91 children confirmed that pain and distress were problems. It highlighted inconsistencies in management as a common feature. Following introduction of the LAPPS tool and treatment protocol, a second audit of 72 children was undertaken. Although only 46 per cent of pathways were satisfactorily completed, the percentage of patients described as 'inconsolable, screaming and withdrawn' reduced from 29 per cent to 9 per cent. Introduction of the LAPPS assessment tool and treatment protocol reduced pain and distress during removal of chest drains. Research is needed to test the psychometrics of the tool and the effectiveness of the treatment protocol prior to wider use.

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Section: Discussionmentioning

confidence: 99%

Introducing LAPPS (Liverpool Anticipatory Procedural Pain Score)

Craske

Dooley

Griffiths

et al. 2013

J Child Health Care

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show abstract

“…In the study of Larsson et al venipuncture was compared to a small or large lancet, respectively, in neonates who underwent testing for phenylketonuria. Successful sampling with only one skin puncture was successful in 86,19, and 40 % of the cases, while median time to finalize collection was 191, 419, and 279 s, respectively. This also resulted in lower pain scores in the venipuncture group (Neonatal Facial Coding Score [NFCS]) (247) compared to both heel lancing techniques (333 and 460, respectively) [45].…”

Section: Preventive Strategiesmentioning

confidence: 98%

“…Data in infants documented that nebulized lidocaine is not effective to reduce the pain response to nasogastric tube placement [86]. In contrast, lingual 24 % sucrose is effective in reducing the behavioral and physiological pain response to nasogastric tube insertion in preterm infants [87].…”

Section: Topical and Local Anesthesiamentioning

confidence: 99%

Sedation in the Neonatal Intensive Care Unit: International Practice

Allegaert

Anker

2014

Pediatric Sedation Outside of the Operating Room

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Inadequate pain management in neonatal life impairs neurodevelopmental outcome because it alters pain thresholds, pain-or stress-related behavior, and physiological responses later in life. However, there are recently also emerging animal experimental and human epidemiological data on the impact of analgo-sedatives on neuro-apoptosis and impaired neurodevelopmental outcome. As a consequence, the management of neonatal pain is in search of a new balance, and these conflicting observations are the main drivers to tailor our pain management in neonates. Adequate pain management is based on prevention, assessment, and treatment with subsequent reassessment. Issues related to prevention and assessment tools are covered. Non-pharmacological (e.g., complementary interventions like facilitated tucking, nonnutritive sucking) and pharmacological (e.g., acetaminophen, opioids, ketamine, propofol) treatment modalities were reviewed and reflect the increased knowledge on neonatal pain management. Each topic ends with some take-home messages that in part also reflect our opinion on the current status of this topic.

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“…Nebulized lidocaine has been purported to relieve the pain of nasogastric tube placement, 117 bronchoscopy, 118,119 and endotracheal intubation, 120 although not all studies show efficacy. 121,122 Tetracaine has been used for a similar purpose but has the potential disadvantage of producing methemoglobinemia with overdose. 123 The addition of fentanyl to nebulized lidocaine may offer additional benefit.…”

Section: Local Anestheticsmentioning

confidence: 99%

Aerosolized Surfactants, Anti-Inflammatory Drugs, and Analgesics

Willson

2015

Respir Care

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Drug delivery by aerosol may have several advantages over other modes, particularly if the lung is the target organ. Aerosol delivery may allow achievement of higher concentrations while minimizing systemic effects and offers convenience, rapid onset of action, and avoidance of the needles and sterile technique necessary with intravenous drug administration. Aerosol delivery may change the pharmacokinetics of many drugs, however, and an awareness of the caveats of aerosolized drug delivery is mandatory to ensure both safety and adequate drug delivery. This paper discusses the administration of surfactants, anti-inflammatory agents, and analgesics by the aerosol route.

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Does Nebulized Lidocaine Reduce the Pain and Distress of Nasogastric Tube Insertion in Young Children? A Randomized, Double-Blind, Placebo-Controlled Trial

Cited by 41 publications

References 29 publications

Introducing LAPPS (Liverpool Anticipatory Procedural Pain Score)

Introducing LAPPS (Liverpool Anticipatory Procedural Pain Score)

Sedation in the Neonatal Intensive Care Unit: International Practice

Aerosolized Surfactants, Anti-Inflammatory Drugs, and Analgesics

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