Academic journal article Research and Theory for Nursing Practice

Nonpharmacological Techniques to Reduce Pain in Preterm Infants Who Receive Heel-Lance Procedure: A Randomized Controlled Trial

Academic journal article Research and Theory for Nursing Practice

Nonpharmacological Techniques to Reduce Pain in Preterm Infants Who Receive Heel-Lance Procedure: A Randomized Controlled Trial

Article excerpt

Introduction: The heel-lance (HL) method for blood collection from the newborn is controversial for the pain it causes. This is the first randomized controlled trial on the management and reduction of pain using the music of Wolfgang Amadeus Mozart ("Sonata K. 448") in premature infants hospitalized in a neonatal intensive care unit (NICU). This study has compared nonpharmacological techniques with standard procedure for reducing pain during HL procedure. Methods: Thirty-five premature infants were enrolled, each for 3 HL procedures, of which each was ran- domized to 1 of the 3 study arms. Arms were then compared in terms of the Premature Infant Pain Profile (PIPP) changes by analysis of variance (ANOVA). Results: One hundred five HL procedures were available for analysis (35 standard procedure, 35 music, 35 glucose). Median baseline PIPP was 3, and median PIPP after the HL procedure was 5. PIPP scale change was 13 in the control arm, 11 in the glucose arm, 12 in the music arm (p = .008). Discussion: Both glucose and music were safe and effective in limiting pain increase when compared to standard procedure in HL procedures in preterm infants.

Keywords: pain; music; glucose; infant premature

The heel-lance (HL) method for blood collection from the newborn is contro- versial for the pain it causes and an increased risk of skin lesions, such as bruising of the puncture site and inflammation (Vertanen, Fellman, Brommels, & Viinikka, 2001). Venipuncture is preferred because it is less painful and more effective (Lago et al., 2009; Morrow, Hidinger, & Wilkinson-Faulk, 2010), but HL is often the only viable option for a blood collection in the care of preterm infants. Preterm infants have the capacity to feel pain at birth, and this can have adverse short- and long-term effects from pain (Fitzgerald, 1991; Johnston, Fernandes, & Campbell-Yeo, 2011). The pain related with heel lancing is closely associated with squeezing of the heel rather than breaking of the skin via the heel prick (Morrow et al., 2010). Squeezing is itself a cause of pointless pain (Lago et al., 2009); more- over, the development of the nervous system is extremely vulnerable to peripheral lesions (Fitzgerald, 1991). The existing guidelines for the management of pain in newborns (Lago et al., 2009; Spence et al., 2010; Vani, 2011) suggest several strate- gies to reduce pain in this setting, including environmental, pharmacological, and nonpharmacological measures.

NONPHARMACOLOGICAL INTERVENTIONS TO REDUCE PAIN IN PRETERM INFANTS DURING HEEL LANCE

The use of nonpharmacological techniques for pain control was poor in all European countries, although it showed a routine use of pacifiers and sucrose solutions in most European neonatal intensive care units (NICUs) except in Spain and the United Kingdom; positioning and wraps are used primarily in Scandinavia, the Netherlands, and Belgium. Procedures not specifically recommended by the guidelines are often used; for example, warming of the heel (often in Denmark and Spain) and the use of local anesthetics (lidocaine 2.5% and prilocaine 2.5%), and eutectic mixture of local anestetics cream (in France and Italy; Losacco et al., 2011). So, despite the tools provided by the scientific literature, there are significant differences in the clinical practice of various NICU, the ability to prevent and treat neonatal pain has not improved along with the ability to recognize and measure it.

Focusing on nonpharmacological measures, the use of oral sucrose and non- nutritive sucking (NNS) or human milk is suggested or, alternatively, glucose use (Lago et al., 2009; Okan, Coban, Ince, Yapici, & Can, 2007). Multiple doses of glucose/sucrose (2 min immediately before and 2 min after the HL) appear more effective than a single dose (Lago et al., 2009). NNS seems to have a syn- ergistic effect with the sweet taste, and it is recommended whenever possible (Lago et al., 2009).

The Use of Music

Another nonpharmacological intervention used to reduce pain in premature infants is listening to music. …

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