Measurement of post-operative pain and narcotic administration in infants using a new clinical scoring system

Barrier, G.; Attia, Josef Zekry; Mayer, M; Amiel-Tison, Cl.; Shnider, Sol M.

doi:10.1007/bf00260883

Cited by 88 publications

(53 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Finally, composite pain measures are also currently available. The most commonly used composite measures are the PIPP, 19 Barrier et al 34 postoperative clinical scoring system, the Neonatal Infant Pain Scale 35 and the Crying, Requires Oxygen, Increased Vital Signs, Expression and Sleepless Tool (CRIES). 36 With the abundance of choice in outcome measures, it is no wonder that investigators who have evaluated the efficacy of EMLA in neonates have utilized very diverse pain indicators in their studies.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Lidocaine-Prilocaine Cream (EMLA) in the Treatment of Acute Pain in Neonates

et al. 1998

View full text Add to dashboard Cite

ABSTRACT. Objective. Neonates routinely undergo painful cutaneous procedures as part of their medical treatment. Lidocaine-prilocaine 5% cream (EMLA) is a topical anesthetic that may be useful for diminishing the pain from these procedures. EMLA is routinely used in children and adults. There is substantial apprehension about its use in neonates because of concerns that it may cause methemoglobinemia. The objective of this review was to determine the efficacy and safety of EMLA as an analgesic for procedural pain treatment in neonates and provide evidence-based recommendations for clinical practice.Methods. Systematic review techniques were used. Studies were identified using manual and computeraided searches (Medline, EMBASE, Reference Update, personal files, scientific meeting proceedings). Behavioral (eg, facial action, crying) and physiologic (eg, heart rate, oxygen saturation, blood pressure, respiratory rate) outcome data from prospective nonrandomized controlled studies and randomized controlled trials in fullterm and preterm neonates were accepted for inclusion to establish efficacy of EMLA. The risk of methemoglobinemia (defined as methemoglobin concentration >5% and requiring medical intervention) was estimated from all prospective studies.Results. Eleven studies of the efficacy of EMLA were included in the analysis. Infant gestational age at the time of delivery ranged from 26 weeks to full-term. Two studies included data from both neonates and older infants. The following procedures were studied: circumcision (n ‫؍‬ 3), heel lancing (n ‫؍‬ 4), venipuncture (n ‫؍‬ 1), venipuncture and arterial puncture (n ‫؍‬ 1), lumbar puncture (n ‫؍‬ 1), and percutaneous venous catheter placement (n ‫؍‬ 1). Nine studies were randomized controlled trials. The total sample size for each study ranged from 13 to 110 neonates. The dose of EMLA used was 0.5 g to 2 g in 9 studies, and was not specified in the others. The duration of application ranged from 10 minutes to 3 hours. The three studies that investigated the efficacy of EMLA for decreasing the pain of circumcision used a randomized controlled trial design. All of them demonstrated significantly reduced crying time during the procedure in the infants in the EMLA group compared with the infants in the control group. Facial grimacing, assessed in two of the studies, was also significantly lower in the EMLA group. Using meta-analytic techniques, the heart rate outcome data for two studies was summarized. Increases in heart rate compared with baseline values were 12 to 27 beats per minute less for the EMLA group than in the placebo group during various stages of the surgical procedure. Three studies that investigated the pain from heel lancing were randomized controlled trials; the other was a nonrandomized controlled study. None demonstrated a significant benefit of EMLA for any of the outcome measures used to assess pain (ie, behavioral pain scores, infant crying, heart rate, blood pressure, respiratory rate, oxygenation parameters). One randomized controlled study ...

show abstract

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Lidocaine-Prilocaine Cream (EMLA) in the Treatment of Acute Pain in Neonates

et al. 1998

View full text Add to dashboard Cite

show abstract

“…The need for analgesia was deduced from physiological, neurological and behavioral reactions such as sleep during the preceding hour, facial expres sion, quality of crying, spontaneous motor activity, movements of the limbs and body, irritability, re sponses to handling and consolability [19], together with measured cardiorespiratory changes. Diuresis was measured as a routine procedure in the case of crit ically sick neonates and after surgery.…”

Section: Introductionmentioning

confidence: 99%

Age-Related Morphine Kinetics in Infants

Pokela¹,

Olkkola²,

Seppαlä³

et al. 1993

Dev Pharmacol Ther

View full text Add to dashboard Cite

The pharmacokinetics of morphine was studied in 27 infants receiving a single intravenous dose of 0.1 mg/kg morphine after surgery (n = 23) or during mechanical ventilation (n = 4). The pharmacokinetics of morphine varied greatly between the subjects, especially in the neonates. The clearance and half-life varied distinctly with postnatal age. The mean ( ± SD) half-life was 8.1 ± 8.1 h in 10 neonates younger than 1 week, 5.4 ± 3.4 h in 10 infants aged from 1 week to 2 months and 2.6 ± 1.7 h in 7 infants aged from 2 to 6 months. Mean clearance increased significantly with age, being 8.7 ±5.8 ml/min/kg in the youngest age group, 11.9 ± 5.1 ml/min/kg in those aged 1 week to 2 months and 28.0 ± 8.9 ml/min/kg in those aged 2-6 months, and was also significantly lower in the critically ill infants. The clearance and half-life of morphine begin to approach adult values after the age of 1 month, but great individual variability exists even after that. In order to reduce the risk of overdosing or underdosing, the dose of morphine should be titrated individually.

show abstract

“…38 It has 13 dimensions that include sleep, facial expression, quality of cry, spontaneous motor activity, excitability and responsiveness to stimulation, flexion of fingers and toes, suckling, overall tone, consolability, sociability, and physiologic changes in heart rate, blood pressure, and saturation. Each dimension is scored 0 to 2, and a higher score is an indication of less pain.…”

Section: The Distress Scale For Ventilated Newborn Infants (Dsvni) 52mentioning

confidence: 99%

“…Between 1978 and 2004, 17 unidimensional pain assessment tools were published in the literature [25][26][27][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] ; the most recent was published in 2001. One unpublished tool, the Mills Infant and Toddler Pain Index, which was based on the work of others, 11 was also identified.…”

Section: Unidimensional Pain Assessment Toolsmentioning

confidence: 99%

A Systematic Integrative Review of Infant Pain Assessment Tools

Duhn¹,

Medves²

2004

Advances in Neonatal Care

206

124

View full text Add to dashboard Cite

When choosing a pain assessment tool, one must also consider the infant population and setting, and the type of pain experienced. The decision should be made after carefully considering the existing published options. Confidence that the instrument will assess pain in a reproducible way is essential, and must be demonstrated with validity and reliability testing. Using an untested instrument is not recommended, and should only occur within a research protocol, with appropriate ethics and parental approval. Because pain is a multidimensional phenomenon, well-tested multidimensional instruments may be preferable.

show abstract

Measurement of post-operative pain and narcotic administration in infants using a new clinical scoring system

Cited by 88 publications

References 4 publications

A Systematic Review of Lidocaine-Prilocaine Cream (EMLA) in the Treatment of Acute Pain in Neonates

A Systematic Review of Lidocaine-Prilocaine Cream (EMLA) in the Treatment of Acute Pain in Neonates

Age-Related Morphine Kinetics in Infants

A Systematic Integrative Review of Infant Pain Assessment Tools

Contact Info

Product

Resources

About