Procedural Pain Management Research Articles

Maternal voice reduces procedural pain in neonates: A meta-analysis of randomized controlled trials.

Procedural pain management is a very important part in the clinical care of neonates. We aimed to conduct a meta-analysis to evaluate the effects of maternal voice on neonatal procedural pain, to provide insights to the clinical pain care of neonates. Two researchers independently searched PubMed, EMBASE, The Cochrane Library, CINAHL, Web of Science, China Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang and Weipu Database for randomized controlled trials (RCTs) involving the effects of maternal voice on the procedural pain of neonates up to October 25, 2022. Two investigators screened the literature based on the inclusion and exclusion criteria and evaluated the methodological quality of the inclusion study. RevMan 5.3 software was used for the meta-analysis. A total of 8 RCTs with a total of 584 neonates were included. Our meta-analysis indicated that maternal voice reduces the pain score (SMD = -0.60, 95% CI: -0.81 to -0.39) and heart rate (SMD = -0.81, 95% CI: -1.44 to -0.18) and increases the comfort level (SMD = -0.47, 95% CI: -0.83 to -0.11) and blood oxygen saturation (SMD = 0.70, 95% CI: 0.03-1.38) during procedure (all P < .05). Moreover, maternal voice reduces the pain score (SMD = -0.58, 95% CI: -0.88 to -0.28) and heart rate (SMD = -0.44, 95% CI: -0.75 to -0.12) and increases the blood oxygen saturation (SMD = 0.41, 95% CI: 0.00 to -0.82) after procedure (all P < .05). No publication biases were detected by the funnel plots and Egger tests (all P > .05). Maternal voice is beneficial to reduce procedural pain and improve the physiological indicators in neonates. It is still necessary to conduct high-quality, large sample studies in the future to further elucidate the effect of maternal voice on neonatal pain care.

Parenting Pain Away: Development and usability testing of an educational website about infant procedural pain management.

All newborns undergo minor painful procedures (e.g., injections). Despite strong evidence supporting parents' efficacy to reduce procedural pain (e.g., breastfeeding), parents remain an underutilized resource. Limited evidence-based resources about infant procedural pain management targeting parents in the perinatal period exist. We co-created Parenting Pain Away, a website to enhance parents' access to information and participation in procedural pain management following birth. This study aimed to conduct iterative usability testing with the perinatal population to refine Parenting Pain Away based on target users' identified needs and satisfaction. In 2020, parents of healthy newborns or expectant parents from an Atlantic Canadian province, participated in two iterative cycles of usability testing of Parenting Pain Away. Through recorded interviews, participants were directed to use the "Think Aloud" approach (e.g., verbalize what they see, think, feel) as they navigated through the website. Participants completed online questionnaires related to demographics and user satisfaction, measured by the Post Study System Usability Questionnaire (PSSUQ). Descriptive statistics and content analysis were conducted to analyze the data. In total, there were 10 participants with an average age of 29.9 years (SD=3.9). Participants identified as mothers (n=7) or fathers (n=3) and were expecting (n=6) or had a newborn (n=4). The PSSUQ overall scores were 1.84 (SD=0.55) and 1.34 (SD=0.49) in Cycles 1 and 2, respectively, indicating high user satisfaction on the 7-point scale. When comparing between the two cycles, the average overall score was lower in Cycle 2, suggesting improved satisfaction. Participants provided positive feedback about the website and suggested major refinements to simplify content and site navigation. Findings from usability testing cycles were used to inform refinements of the Parenting Pain Away in response to participant satisfaction and feedback. Engaging target users in the development process enhanced this website in preparation for further effectiveness testing.

Clinical study PEPCA : The effect of standardized preoperative patient education for patient-controlled regional analgesia on postoperative pain

Patient-controlled analgesia (PCA) is awell-established form of postoperative pain management. One form of administration is patient-controlled regional analgesia (PCRA), where local anesthetics are administered via peripheral regional catheters; however, a prerequisite is that the patients are instructed on its use. Amultitude of sources recommend that these instructions are given before surgery as preoperative training on pain management procedures has been shown to significantly reduce patients' postoperative pain and increase their well-being. The aim was to assess the effect of guideline-assisted preoperative patient education for PCRA on postoperative pain in patients undergoing orthopedic surgery compared to unstructured postoperative standard instructions. Acontrolled study with two randomized samples and apostinterventional survey was conducted. Overall, 73patients with PCRA catheters for orthopedic surgery were enrolled in the study. The 37participants in the interventional group (IG) received guideline-based structured instructions on PCRA use as well as ahandout immediately before the surgical intervention. The 36patients in the control group (CG) received postoperative instructions in the anesthesia recovery room. Pain was documented according to the numerical rating scale (NRS) at 2h (t1), 6h (t2), and 24h (t3) after surgery. There were no statistically significant differences in the average pain scores between the two groups; however, there were lower mean pain scores in the IG at t1 and t3. Asignificant reduction of pain in the IG could not be shown. Further studies concerning this topic with larger samples and adapted points in time are recommended.

Analgesic Role of Breastfeeding: Analysis of Effectiveness, Implementation Barriers, and Strategies to Promote Evidence-Based Practice

Objective:Exposure to painful stimuli serves as toxic stress for infants, increasing their subsequent pain sensitivity and resulting in neurodevelopmental impairments. Besides offering nutritional, psychological, immunological, and economic benefits, breastfeeding is reported as the most effective analgesia for the management of minor procedural pain in infants. Although breastfeeding holds several advantages, implementation of this nonpharmacological intervention is still uncommon in many clinical settings.Methods:This scoping review presents an analysis of 29 clinical trials that compare the effectiveness of breastfeeding with other nonpharmacological methods.Findings:Breastfeeding is an efficacious analgesia compared with sucrose, sweet solutions, and other nonpharmacological methods. When used alone or in combination with other nonpharmacological interventions, breastfeeding reduces infants’ biobehavioral responses to pain and promotes faster physiologic recovery after painful procedures. Breastfeeding is recommended as the first choice whenever feasible. Barriers to the uptake of this effective pain management method in clinical practice include misinformation/inconsistent use of evidence, an infant’s impaired sucking reflex, maternal–child separation, the workload of healthcare professionals, a lack of parental involvement, assumptions of healthcare providers, and a lack of adequate information/guidance for parents. Strategies to promote the uptake of breastfeeding for the management of procedural pain in infants include an effective partnership between healthcare providers and breastfeeding mothers, knowledge mobilization resources in multiple languages, informational support and media campaigns, and experiential learning opportunities for breastfeeding mothers.Conclusions:Successful implementation of baby-friendly hospital initiatives, a patient-centered approach, family-centered care, and the collaborative efforts of healthcare providers in all healthcare settings is recommended to promote the uptake of breastfeeding as analgesia.

Effect of Non-nutritive Sucking during Heel-stick Procedure in Pain Management of Term Infants in the Neonatal Intensive Care Unit: A Systematic Review and Meta-analysis.

This study aimed to evaluate the efficacy of non-nutritive sucking for analgesia in term infants undergoing heel-stick procedures. Randomized controlled trials and non-randomized studies based on the PICO framework were included in the study. Review articles, commentary, pilot, and non-English articles were excluded. Databases, such as PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane, were searched until January 31st, 2021, using the keywords "Pain management", 'Non-nutritive sucking", and "Heel stick". All studies were reviewed and retrieved by two authors independently using a standardized form according to the inclusion criteria, and any disagreements were examined by a third scholar. Quality assessment was evaluated by using the ROB-2 tool. Data were analyzed using Stata version 12.0 software, and a random-effects model was used for analysis. A total of 5,629 articles were retrieved from all databases, and after the screening, finally, 6 relevant articles were included in the analysis. The tools used to control pain in infants in the articles included PIPP, NFCS, NIPS, and NPASS. The results showed that the pain scores were significantly lower in the NNS group compared to the control group (MD, -1.05; 95% CI, -1.53 to -0.57) and NNS had a significant effect on oxygen saturation (O2 Sat) increasing in newborns compared to the control group, but no significant reduction in the heart rate (HR) between two groups was observed. NNS effectively provides analgesia in full-term neonates undergoing heel-stick procedures; however, its effects on the long-term outcomes of infants are unclear. The results showed that NNS was effective in improving heel-stick pain in infants.

Analgesic Role of Breastfeeding: Analysis of Effectiveness, Implementation Barriers, and Strategies to Promote Evidence-Based Practice

Objective:Exposure to painful stimuli serves as toxic stress for infants, increasing their subsequent pain sensitivity and resulting in neurodevelopmental impairments. Besides offering nutritional, psychological, immunological, and economic benefits, breastfeeding is reported as the most effective analgesia for the management of minor procedural pain in infants. Although breastfeeding holds several advantages, implementation of this nonpharmacological intervention is still uncommon in many clinical settings.Methods:This scoping review presents an analysis of 29 clinical trials that compare the effectiveness of breastfeeding with other nonpharmacological methods.Findings:Breastfeeding is an efficacious analgesia compared with sucrose, sweet solutions, and other nonpharmacological methods. When used alone or in combination with other nonpharmacological interventions, breastfeeding reduces infants’ biobehavioral responses to pain and promotes faster physiologic recovery after painful procedures. Breastfeeding is recommended as the first choice whenever feasible. Barriers to the uptake of this effective pain management method in clinical practice include misinformation/inconsistent use of evidence, an infant’s impaired sucking reflex, maternal–child separation, the workload of healthcare professionals, a lack of parental involvement, assumptions of healthcare providers, and a lack of adequate information/guidance for parents. Strategies to promote the uptake of breastfeeding for the management of procedural pain in infants include an effective partnership between healthcare providers and breastfeeding mothers, knowledge mobilization resources in multiple languages, informational support and media campaigns, and experiential learning opportunities for breastfeeding mothers.Conclusions:Successful implementation of baby-friendly hospital initiatives, a patient-centered approach, family-centered care, and the collaborative efforts of healthcare providers in all healthcare settings is recommended to promote the uptake of breastfeeding as analgesia.

Pain management in outpatient urologic procedures: A prospective randomized trial of oxycodone versus ketorolac

Objectives: The objectives of the study were to evaluate the efficacy of ketorolac for pain control compared to oxycodone after routine outpatient urologic procedures and to characterize medication overprescription and disposal. Materials and Methods: A prospective randomized trial of 150 adults (75 in the ketorolac arm and 75 in the oxycodone arm) who underwent outpatient urologic procedures over 12 months was performed. Baseline and follow-up pain scores were elicited from 55 of these patients (30 ketorolac patients and 25 oxycodone patients), and improvement in pain scores was calculated. Wilcoxon rank-sum test was used to analyze changes in pain scores within and between groups. Pill disposal methods were also recorded. Results: Pain significantly decreased in both oxycodone (5/10 at baseline and 3/10 at follow-up) and ketorolac (4/10 at baseline and 3/10 at follow-up) groups. No statistically significant differences in pain improvement were found between groups, despite patients in the oxycodone group taking a higher number of pills (one ketorolac pill vs. four oxycodone pills). A large portion of patients in both groups also did not fill their analgesics (14.7% of oxycodone and 38.7% of ketorolac). Patients in the oxycodone group were more likely to keep surplus pills than ketorolac patients (61.3% vs. 38.7%). Conclusion: Ketorolac is a noninferior alternative to oxycodone following outpatient urologic procedures. Patient and physician education is necessary to curtail the indiscriminate prescription, use, and disposal of opioids.

Implementation of a Non-Sedated Procedural Pain Management Practice Guideline and Order Set

Implementation of a Non-Sedated Procedural Pain Management Practice Guideline and Order Set

Recent trends in chronic pain medicine.

Chronic pain presents as an unequalled challenge for physicians, owing to the complexity of biochemical and biological pathways involved in pain transmission and high variability of pain perception among individuals. Often, there is an inadequate response to conservative treatment, and opioid treatment has its own drawbacks, such as side effects and opioid dependence. Hence, novel strategies have evolved for the effective and safe management of chronic pain. Radiofrequency technique, regenerative biomaterial, platelet-rich plasma, mesenchymal stem cells, reactive oxygen species scavenger nanomaterial, ultrasound-guided interventional pain management procedures, endoscopic spinal procedures, vertebral augmentation therapy, and neuromodulation are some of the promising and upcoming modalities in the armamentarium of pain physicians.

Comparison of the Effects of Alcohol and Phenol Used for Celiac Neurolysis with Endoscopic Ultrasound in Patients with Pancreas Cancer: Retrospective Analysis

Objective: In this study we aimed to compare the efficacy of ethanol and phenol used in the EUS-guided celiac plexus neurolysis procedure on pain scores and complications. Material and Methods: Between January 2009 and June 2022, 28 patients who underwent celiac neurolysis underwent sedation via EUS (endoscopic ultrasonography) guidance in the endoscopy unit were included. We retrospectively analyzed the data of the EUS-guided celiac neurolysis procedures for pain management of patients with pancreatic cancer. Results: Patients in the alcohol group had lower pain scores. Conclusion: When alcohol and phenol-based neurolytic techniques were compared, better analgesic effect was obtained in the alcohol group.

Is Virtual Reality a Game Changer in Pediatrics' Acute Pain Perception?

Purpose of review: Virtual reality (VR) is a promising tool that is becoming increasingly popular for the prevention and treatment of procedural pain in children. This review aims to investigate the current literature on the use and effectiveness of VR in paediatric procedural pain management, focusing on needle-related procedures, burn wound care, dental procedures among others; limitations and future perspectives on the use of VR will also be highlighted.&#x0D; Recent findings: in addition to the most researched fields of application (e.g. needle procedures), VR has also started to be used in new areas, such as nasal and gastrointestinal endoscopies as well as minor surgeries. From the latest evidence, VR seems to be effective in many procedures, especially compared to no distraction; however, there is conflicting data in the literature due to numerous factors such as differences between technologies, degree of VR-immersion, patients coping styles among others.&#x0D; Summary: there are still no data of absolute certainty on the effectiveness of VR in reducing procedural pain in paediatric patients and data pooling is still difficult. Future research should carry on large randomised-controlled, multicentre studies to better define VR properties and how best to optimise VR software and user experience for maximum pain reduction.

A prospective study in management of lumbar radiculopathy patients with selective nerve root block

Background: Prolapsed Intervertebral Disc (PID) was considered to be the commonestcause of sciatica among many others. Though the presentation of sciatica wasparadoxical, in which, some people experienced sciatica without any disc prolapse onMRI/CT, whereas some people showed a prolapsed disc without experiencing any ofthe symptoms related to sciatica. This gave rise to different explanations that a discprolapse in itself , is not enough to cause sciatica, and there might be some localchemical agents that might be the causative factor due to their insulting attitude on thenerve roots.Objectives:To study the functional outcome of patients with Posterior LumbarIntervertebral disc prolapse (PLIVDP), Lumbar Canal Stenosis, andLumbar radiculopathy after Selective Nerve Root Block at thecorresponding level.Materials and Methods:A prospective cohort study on the functional outcome of patients with lumbarradiculopathy with Intervertebral disc prolapse or lumbar canal stenosis. Outcomemeasures used in this study are Owestry disability index score and Numerical ratingscale. All patients had taken an MRI scan, which was classified according to theMichigan state university classification. After initial check up, pre-anaestheticcheckup, selected patients were given Selective Nerve Root Block with MethylPrednisolone and local anaesthetic Bupivacaine. Patients were scored at Immediatepost Op, 3 weeks and 3 months after the injection was given and the data wascollected.Results:A total of 127 patients were given Selective Nerve Root Block in the studyperiod. Patients that were aged from 20-80 years were included. Average pre-injection ODI scores (in percent) were 75.24, at 1 month 20.52and at 4 months 19.86, with a p value of &lt;0.001. Mean NRS ratings pre injectionwere 8.73, Immediate post op were 1.89, at 4 weeks it was 1.48 and 4 months 1.27. MeanSLR (in degrees) Pre Injection was 48.3, Immediate was 80.00, at 4 weeks was 80.2 and at 4 months was 80.5.Conclusion:Selective Nerve Root Block is a good therapeutic procedure for pain management in the patients with Lumbar radiculopathy, and it can be used as a standard procedure, before advising the patient for any form of surgery Keywords: SNRB, Lumbar canal stenosis, Sciatica, Radiculopathy

Development, evaluation and adaptation of a critical realism informed theory of procedural pain management in preterm infants: The PAIN-Neo theory.

To present the development, evaluation and adaptation of the PAIN-Neo theory. Theory development. A review of literature was conduct from 1980 to 2021. Using a critical realism paradigm, this paper presents the PAIN-Neo theory, which was developed from an analysis of existing theoretical perspectives on paediatric procedural pain, empirical studies conducted with preterm infants, and the research team's pain management expertise. The theory was then empirically tested and fine-tuned. The PAIN-Neo theory highlights that the neonatal nurse is part of a larger picture as she is influenced by factors related to her unit, hospital and country of practice. This theory emphasizes the importance of parental involvement in pain management, which is consistent with family-centred nursing practices. The PAIN-Neo theory reflects the complexity of pain management nursing. This theory is innovative and specific enough to guide practice, structure research projects and contribute to the body of knowledge in the discipline of nursing.

Multimodal locoregional procedures for cancer pain management: a literature review.

Pain is the most common and fearsome symptom in cancer patients, particularly in the advanced stage of disease. In cancer pain management, the first option is represented by analgesic drugs, whereas surgery is rarely used. Prior to considering surgical intervention, less invasive locoregional procedures are available from the wide pain management arsenal. In this review article, comprehensive information about the most commonly used locoregional options available for treating cancer pain focusing on interventional radiology (neurolysis, augmentation techniques, and embolization) and interventional radiotherapy were provided, also highlighting the potential ways to increase the effectiveness of treatments.

Health disparities in regional anesthesia and analgesia for the management of acute pain in trauma patients.

Health disparities in regional anesthesia and analgesia for the management of acute pain in trauma patients.

Efficacy of Single Wound Infiltration With Bupivacaine and Adrenaline During Cesarean Delivery for Reduction of Postoperative Pain

Most women report moderate to severe pain after cesarean delivery. The extent of the ability of surgical wound infiltration with local anesthetic agents during cesarean delivery for the reduction of postoperative pain is uncertain. To examine the efficacy of single wound infiltration with bupivacaine and adrenaline during cesarean delivery for the reduction of postoperative pain. This randomized clinical trial was conducted between January 25, 2018, and May 30, 2020, at a university teaching hospital in Afula, Israel. A total of 288 women with singleton pregnancy who were scheduled for a planned cesarean delivery at term were randomized to receive single wound infiltration with bupivacaine and adrenaline during cesarean delivery (intervention group) or no single wound infiltration (control group) at a 1:1 ratio. In the intervention group, the subcutaneous layer was infiltrated on both sides of the wound by a mixture of bupivacaine and adrenaline before wound closure. Other perioperative techniques were similar between the groups. The primary outcome was mean pain intensity over the course of 24 hours after the operation, as measured by a visual analog scale (VAS) score ranging from 0 to 10 (with higher scores indicating greater pain intensity). To detect a mean (SD) reduction of 1 (3) points in the VAS score in the intervention group, 286 women were needed in total. Secondary outcomes included VAS score greater than 4 (indicating moderate pain) at 2 hours after the operation, use of rescue opioids, maternal satisfaction with the pain management procedure (using a scale of 1-5, with higher scores indicating greater satisfaction), duration of the operation, scar complications (hematoma, infection, and separation), and length of stay. Among 288 women (mean [SD] age, 32.5 [5.1] years; all of Arab or Jewish ethnicity), 143 were randomized to the intervention group, and 145 were randomized to the control group. Demographic and obstetric variables were similar between groups. The primary outcome (VAS pain score) was significantly lower in the intervention group (mean [SD], 2.21 [0.56]) compared with the control group (mean [SD], 2.41 [0.73]; P = .02). In the intervention group, 11 women (7.7%) had a VAS score greater than 4 at 2 hours compared with 22 women (15.2%) in the control group (odds ratio, 0.47; 95% CI, 0.22-1.00; P = .05). In addition, compared with the control group, the intervention group had significantly lower postpartum use of rescue opioid analgesics (19 women [13.3%] vs 37 women [25.5%]; P = .009) and greater satisfaction with pain management (mean [SD] score, 4.65 [0.68] vs 4.44 [0.76]; P = .007). In the intervention vs control groups, duration of the operation, scar complications (hematoma, infection, or separation), and length of stay were comparable. In this study, wound infiltration with a single administration of bupivacaine and adrenaline during cesarean delivery reduced postoperative pain and opioid use and may have improved maternal satisfaction with pain management. These findings suggest the technique is efficacious, safe, and easy to perform. ClinicalTrials.gov Identifier: NCT03395912.

Evidence-based practical guideline for procedural pain management and sedation for burn pediatrics patients undergoing wound care procedures.

Almost all children with burns experience pain as a result of a complex pathophysiologic process that is usually untreated, and up to 38% of all pediatric burn victims develop anxiety disorders due to pain after hospital admission. Hence, it is important to manage pain and anxiety in the care of burn victim children. The goal of this review was to develop an evidence-based guideline for procedural pain management and sedation for burned children undergoing wound care procedures. The review was reported according to Reporting Items for practice Guidelines in Healthcare (RIGHT) protocol. A search of literature was done from Cochrane review, PubMed, Google Scholar, Embase, web of science and Hinari database key words "pediatrics", "children", "burn", "procedural wound care", "wound dressing", "non-pharmacological", "analgesia", "pain management" and "sedation" were used. Extraction and filtering of the results was determined based on the interventions, outcome, population, and methodological quality, and inclusion and exclusion criteria. Finally, 6 systematic review and meta-analysis, 1observational study, and 16 randomized control trial Studies were appraised for quality, and conclusion was made based on their level of evidence and grade of recommendation. For effective management of procedural pain and accompanying anxiety during WCP in children, we recommend using non-pharmacological strategies as an adjunct with calculated dose of analgesics based on the children's analgesic requirements. We also recommend ketamine-dexmedetomidine as an effective first-line analgesic-sedation, and ketamine-propofol, propofol-remifentanil, propofol-fentanyl, and ketamine-midazolam as useful sedative-analgesic options.

Prevalent Estimates of HIV/AIDS in Chronically Ill patients admitted in JPMC Karachi Pakistan

Objective: To find out the prevalence of HIV/AIDS in chronically ill patients admitted in tertiary care hospital JPMC(Jinnah Postgraduate Medical Centre) Karachi. Study design &amp; place: This cross-sectional study was conducted at JPMC during the June, 2021 to April, 2022. Materials &amp; Methods: A total of 500 patient age ≥18 years having highly suspicious history &amp; symptoms of HIV/AIDS, admitted in Medical &amp; pulmonology department were included in this study. A well-structured questionnaire was used to obtain background characteristics, clinical symptoms; history of high risk behaviors and I/V drug use of all participants was collected. Confidentiality was assured of all participants given unique identification number. Data was analyzed by using Statistical Package for Social Sciences version 21 (SPSS 21). Results: A total of 500 patients comprised of 373 (74.6%) male and 127 (25.4%) female, male to female ratio was 2.93:1. The mean age was 33.5 ± 12.78 years (18 to 83 years). We observed that most of patients belong with history of blood transfusion, 160 (32%) followed by I/V drug user 130 (26%) and sexual contact 96 (19.2%) cases. Out of 500 study participants, 29(5.8%) subjects were HIV/AIDS positive. The results of this study will provide information and awareness about the transmission of HIV in community. The study revealed that the blood transfusion is a significant risk factor in transmission of HIV. The findings of current study will help doctors for postoperative pain treatment following major abdominal surgery. Acute pain management in hospitals faces some significant obstacles, according to a recent review on postoperative pain management procedures in tertiary care facilities center. Conclusion: Most of the chronically ill patients admitted were men who had been diagnosed with HIV/AIDS. Blood transfusion history, intravenous drug use, and multiple sex partners were important risk factors. There is a need to create awareness among the general public about the risk factors for HIV/AIDS to decelerate the spread of this deadly disease. Keywords: AIDS Acquired immunodeficiency syndrome Chronic diseases, HIV Human Immunodeficiency Virus, Injecting drug user, Multiple sex partners, JPMC Jinnah Postgraduate Medical Centre

Possibilities of Influencing Procedural Pain Associated with Premature Newborn Retinopathy Screening with Oral Clonidine.

The aim of our study was to compare the analgesic/sedative effects of various fundus-related procedural pain management strategies on the risk of retinopathy in premature infants. This was a prospective comparative study involving a total of 94 neonates randomized to three groups meeting the criteria for at-risk neonates. Ophthalmologic screening was performed to evaluate the outcome of three procedural pain management strategies. The intensity of pain over time during and after the screening examination was evaluated. At the same time, we also looked at the occurrence of vegetative symptoms and their influence by the chosen medication. Pain response was observed in all 94 neonates enrolled in the study. In group A, no pain treatment was given. Group B had a local anesthetic oxybuprocaine hydrochloride 0.4% introduced into both eyes immediately prior to the examination. Group C received oral clonidine. The study was conducted as a pilot project and aimed to clarify the problem so that a project with a higher proband representation could take place in the future. Consequently, we performed quantitative analysis of complete pain and vegetative functions, followed by a qualitative analysis of their internal components. In our study, we identified the most considerable effects for all three groups, including NIPS (Neonatal Infant Pain Scale) responses immediately during and after the examination. The influence of vegetative functions is of a longer-term nature and increased values can be clearly demonstrated even six hours after the examination. The current results identify and quantify differences among all three methods of pain treatment on the level of single variables. Their internal structures, however, can be analysed only qualitatively because of the small size of the analysed sample.

Existence and perceived application of pain management protocols in German neonatal intensive care units.

We explored the existence and application of standard operating procedures (SOPs) for pain management (PM) in German neonatal intensive care units (NICUs), and identified the factors associated with their application in practice. This study was part of the Safety4NICU project, a cross-sectional survey conducted from 2015 to 2016. All 224 German NICUs were invited to participate, providing written consent from the head neonatologist and head nurse. We distributed questionnaires to the head neonatologist, the head nurse, and the NICU staff (physicians and nurses). We asked the head neonatologist whether written SOPs for PM existed, and we asked the staff whether these SOPs were applied in their daily routine. We received evaluable responses from 468 physicians and 1251 nurses from 76 NICUs. Of these 76 NICUs, the head neonatologists from 54 NICUs (71.1%) reported that written SOPs for PM exist. However, only 48.5% of the physicians and 53.7% of the nurses declared that these existing SOPs were also applied. We found various predictors for the existing SOPs as being applied, depending on the profession. For physicians, clinical training was important (OR: 2.482, p ≤ 0.05), while for nurses their working experience was a decisive predictor (OR: 1.265, p ≤ 0.05). For both, a high level of perceived cooperative norms between physicians and nurses increased the probability that SOPs for PM were applied, whereas a high bed turnover rate decreased that probability. According to the responses from head neonatologists, written SOPs for PM were common in German NICUs. However, if management strategies on pain existed, this did not mean that these were directly applied in the daily routine. Clinical training of the staff, the promotion of adequate interprofessional cooperation, as well as allowing time to deal with these SOPs might be all essential measures to strengthen the application.