The efficacy of non‐pharmacological interventions in the management of procedural pain in preterm and term neonates

Abstract

Some of the non-pharmacological interventions have an evident favourable effect on pulse rate, respiration and oxygen saturation, on the reduction of motor activity, and on the excitation states after invasive measures. However, unambiguous evidence of this still remains to be presented. Further research should emphasise the use of validated pain assessment instruments for the evaluation of the pain-alleviating effect of non-pharmacological interventions.

Successful Implementation of a Neonatal Pain and Sedation Protocol at 2 NICUs

“…Frequency and quality of assessments, pharmacologic therapy, duration of mechanical ventilation, and outcome were compared between baseline (12 months before implementation) and 12 months after implementation. [2][3][4][5][6][7][8][9][10][11][12][13]; P = .005), and overall staff satisfaction (physicians: 31% vs 89%; P , .001; nurses: 17% vs 55%; P , .001) increased after implementation. Time on mechanical ventilation, length of stay at the ICU, and adverse outcomes were similar before and after implementation.…”

Factors Influencing Neonatal Pain Management from the Perspectives of Nurses and Physicians in a Neonatal Intensive Care Unit: A Qualitative Study

“…In addition, preterm infants are typically hospitalized in a comparatively hostile environment of the NICU, where they undergo numerous tissue-damaging procedures that are part of clinical care (10,11), and each infant may receive 50 -120 medical procedures in 24 hours, many of which are painful (12). Pain has been recognized as the "fifth vital sign" that should be monitored routinely in clinical practices (6).…”

Oral Sucrose and “Facilitated Tucking” for Repeated Pain Relief in Preterms: A Randomized Controlled Trial

“…[15][16][17] They promote self-regulation of the infant and provide oro-tactile, oro-gustatory, and tactile stimulation, capable of reducing infants' pain responses during most painful procedures. 15,[18][19][20][21] Sucrose is recommended extensively for pain relief in preterm infants [22][23][24] and has shown to be highly effective and safe for single procedures by Stevens et al 17 Sweet taste solutions seem to trigger endogenous opioid and nonopioid pathways. 25,26 FT is described as holding the infant by placing a hand on his or her hands and feet and by positioning the infant in a flexed midline position while in either a side-lying, supine, or prone position.…”

“…[10][11][12] As an alternative approach, nonpharmacologic interventions (NPIs) are recommended for pain management. [13][14][15] NPIs (eg, oral sucrose, breastfeeding, non-nutritive sucking, facilitated tucking [FT], kangaroo care, swaddling) effectively reduce pain for minor to moderately painful procedures. [15][16][17] They promote self-regulation of the infant and provide oro-tactile, oro-gustatory, and tactile stimulation, capable of reducing infants' pain responses during most painful procedures.…”

“…[13][14][15] NPIs (eg, oral sucrose, breastfeeding, non-nutritive sucking, facilitated tucking [FT], kangaroo care, swaddling) effectively reduce pain for minor to moderately painful procedures. [15][16][17] They promote self-regulation of the infant and provide oro-tactile, oro-gustatory, and tactile stimulation, capable of reducing infants' pain responses during most painful procedures. 15,[18][19][20][21] Sucrose is recommended extensively for pain relief in preterm infants [22][23][24] and has shown to be highly effective and safe for single procedures by Stevens et al 17 Sweet taste solutions seem to trigger endogenous opioid and nonopioid pathways.…”