Effects of Massage on Postoperative Pain in Infants With Complex Congenital Heart Disease

Abstract

Background Pain management is an essential component of care for pediatric patients following surgery. Massage reduces self-reported postoperative pain in adults with heart disease but has received little attention in postoperative pediatric patients with complex congenital heart disease (CCHD). Objectives The aim of the study was to evaluate the effectiveness of massage compared to a rest period on postoperative pain scores and physiological responses in infants with CCHD. Methods We used a two-group randomized clinical trial design with a sample of 60 infants with CCHD between 1 day and 12 months of age following their first cardiothoracic surgery. Both groups received standard postoperative care. Group 1 received a daily 30-minute restriction of nonessential caregiving (quiet time), and Group 2 received a daily 30-minute massage. Interventions continued for seven consecutive days. Pain was measured six times daily using the Face, Legs, Activity, Cry, Consolability Pain Assessment Tool (FLACC). Average daily doses of analgesics were recorded. Heart rates (HRs), respiratory rates (RRs), and oxygen saturations (SpO2) were recorded continuously. Daily averages, pre- and postintervention FLACC scores, and physiological responses were analyzed using descriptive statistics, generalized linear mixed models repeated measures, latent growth models, and/or regression discontinuity analysis. Fentanyl-equivalent narcotic values were used as a time-varying covariate. Results Adjusted pain scores were lower for the massage group on all days except Day 7. Overall, there were no group effects on level of pain or differential rate of change in pain. However, the massage group had lower daily pain scores with small to medium effect size differences, largest at Days 4, 5, and 6, and lower average daily HR and RR. There was little difference between groups in SpO2. Infants demonstrated immediate effects of massage, with HR and RR decreasing and oxygen saturations increasing. Discussion This study provides beginning evidence that postoperative massage may reduce pain and improve physiological parameters in infants with congenital heart disease. This nonpharmacological adjunct to pain management may provide a particular benefit for this population by reducing demand on the cardiorespiratory system.

Terapias não farmacológicas no alívio da dor pós-operatória de cirurgias cardíacas: revisão de escopo

“…did not specify the type of surgical procedure to which the patient was subjected. Among the studies that specified this data, there was predominance of myocardial revascularization surgeries (17)(18)29) , coronary artery bypass grafts (23,25) , cardiac catheterization (15) and congenital heart disease (13) . It is appropriate to relate a large number of myocardial revascularization surgeries with the prevalence of atherosclerotic diseases (1) .…”

“…Intervention and protocol Outcome/ Pain scale used 2020/ USA (13) Congenital heart disease/ 60 babies Massage for 30 minutes with gentle friction and passive touch on the babies' upper and lower extremity accesses, for seven days.…”

“…Massage corresponds to the most used nonpharmacological technique for pain relief in cardiac surgery PO (13)(14)(15)(16)21,(23)(24)(25)27,29) , followed by the use of music (19)(20)22,(26)(27)(28)(29) , acupressure (19) and aromatherapy (18) .…”

“…The main sites for massage application were as follows: hands (13,(15)(16)21,24) , feet (13)(14)(15)24,29) , arms, shoulders, dorsal region of the abdomen (15) and the area of greatest discomfort reported by the patient (23) . In the intervention, moderate pressure (21,23) , smooth friction movements and passive touch (13) were used, in addition to effleurage, thumb glide and spreading movements (14) .…”

“…Considering the patients' outcome, 11 studies (64.7%) presented significant results regarding the reduction of pain scores (17)(18)22,24) , vital signs, anxiety, muscle tension, fatigue, improvement in mood, relaxation, calm, rest and saturation (13)(14)(15)(16)23,26,28) . Some studies present disagreement in relation to these results, with no significant differences between the intervention and control groups in terms of pain reduction and vital signs (20)(21)25,29) .…”