Efficacy and Safety of Multimodal Analgesic Therapy to Prevent Pain during Screening for Retinopathy of Prematurity

Abstract

Background: Premature infants admitted to the Neonatal Intensive Care Unit are exposed on average to 14 painful procedures per day, as the retinopathy of prematurity screening. Neonatal pain is often underestimated and insufficiently treated, but there are short-term and long-term deleterious effects in premature infants exposed to repetitive pain. Since premature infants cannot verbalize the pain, the use of validated measurement tools is recommended for its evaluation and measurement of pain. The aim of this study was to determine the usefulness of a multimodal analgesic therapy proposed, to prevent pain in premature infants under retinal evaluation. Methods: We carried out a blinded, randomized clinical trial. Premature infants ≤ 34 weeks of gestational age received standard therapy (one drop of tetracaine in each eye) or proposed multimodal analgesic therapy (paracetamol oral at 15 mg/ kg, 30 minutes prior to retinal evaluation, and intranasal fentanyl 2 μg/kg, 5 minutes prior to retinal screening, as well as warm containment and non-nutritional suction. The primary outcome was the score of Premature Infant Pain Profile-Revised (PIPP-R). The application of the score PIPP-R was performed 35 minutes before the procedure, during, and 15 minutes after the procedure. Results: There were no significant differences in PIPP-R score prior to the retinal screening, however, during the retinal evaluation the PIPP-R score was significantly lower in the proposed multimodal therapy group (14.0 vs 6.5, p=0.0001); and 15 minutes after the procedure, score remained lower in the proposed multimodal therapy group (2.9 vs 1.6 p=0.0001). No adverse effects were documented in neither group. In conclusion, retinal screening cause’s deep pain, the topical tetracaine is insufficient to mitigate it. The proposed multimodal therapy can be useful to prevent the pain caused by the procedure and it does not cause adverse effects.