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Calixto GMF, Muniz BV, Castro SR, de Araujo JSM, de Souza Amorim K, Ribeiro LNM, Ferreira LEN, de Araújo DR, de Paula E, Franz-Montan M. Mucoadhesive, Thermoreversible Hydrogel, Containing Tetracaine-Loaded Nanostructured Lipid Carriers for Topical, Intranasal Needle-Free Anesthesia. Pharmaceutics 2021; 13:1760. [PMID: 34834175 PMCID: PMC8617820 DOI: 10.3390/pharmaceutics13111760] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/01/2021] [Accepted: 10/13/2021] [Indexed: 12/04/2022] Open
Abstract
Recent advances have been reported for needle-free local anesthesia in maxillary teeth by administering a nasal spray of tetracaine (TTC) and oxymetazoline, without causing pain, fear, and stress. This work aimed to assess whether a TTC-loaded hybrid system could reduce cytotoxicity, promote sustained permeation, and increase the anesthetic efficacy of TTC for safe, effective, painless, and prolonged analgesia of the maxillary teeth in dental procedures. The hybrid system based on TTC (4%) encapsulated in nanostructured lipid carriers (NLC) and incorporated into a thermoreversible hydrogel of poloxamer 407 (TTCNLC-HG4%) displayed desirable rheological, mechanical, and mucoadhesive properties for topical application in the nasal cavity. Compared to control formulations, the use of TTCNLC-HG4% slowed in vitro permeation of the anesthetic across the nasal mucosa, maintained cytotoxicity against neuroblastoma cells, and provided a three-fold increase in analgesia duration, as observed using the tail-flick test in mice. The results obtained here open up perspectives for future clinical evaluation of the thermoreversible hybrid hydrogel, which contains TTC-loaded NLC, with the aim of creating an effective, topical, intranasal, needle-free anesthesia for use in dentistry.
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Affiliation(s)
- Giovana Maria Fioramonti Calixto
- Department of Biosciences, Piracicaba Dental School, University of Campinas-UNICAMP, Piracicaba 13414-903, Brazil; (G.M.F.C.); (B.V.M.); (J.S.M.d.A.); (K.d.S.A.)
| | - Bruno Vilela Muniz
- Department of Biosciences, Piracicaba Dental School, University of Campinas-UNICAMP, Piracicaba 13414-903, Brazil; (G.M.F.C.); (B.V.M.); (J.S.M.d.A.); (K.d.S.A.)
| | - Simone R. Castro
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas-UNICAMP, Campinas 13083-872, Brazil; (S.R.C.); (E.d.P.)
| | - Jaiza Samara Macena de Araujo
- Department of Biosciences, Piracicaba Dental School, University of Campinas-UNICAMP, Piracicaba 13414-903, Brazil; (G.M.F.C.); (B.V.M.); (J.S.M.d.A.); (K.d.S.A.)
| | - Klinger de Souza Amorim
- Department of Biosciences, Piracicaba Dental School, University of Campinas-UNICAMP, Piracicaba 13414-903, Brazil; (G.M.F.C.); (B.V.M.); (J.S.M.d.A.); (K.d.S.A.)
| | - Lígia N. M. Ribeiro
- Institute of Biotechnology, Federal University of Uberlandia-UFU, Uberlandia 38405-302, Brazil;
| | | | | | - Eneida de Paula
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas-UNICAMP, Campinas 13083-872, Brazil; (S.R.C.); (E.d.P.)
| | - Michelle Franz-Montan
- Department of Biosciences, Piracicaba Dental School, University of Campinas-UNICAMP, Piracicaba 13414-903, Brazil; (G.M.F.C.); (B.V.M.); (J.S.M.d.A.); (K.d.S.A.)
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Abstract
Purpose of review Pain management presents a major challenge in neonatal care. Newborn infants who require medical treatment can undergo frequent invasive procedures during a critical period of neurodevelopment. However, adequate analgesic provision is infrequently and inconsistently provided for acute noxious procedures because of limited and conflicting evidence regarding analgesic efficacy and safety of most commonly used pharmacological agents. Here, we review recent advances in the measurement of infant pain and discuss clinical trials that assess the efficacy of pharmacological analgesia in infants. Recent findings Recently developed measures of noxious-evoked brain activity are sensitive to analgesic modulation, providing an objective quantitative outcome measure that can be used in clinical trials of analgesics. Summary Noxious stimulation evokes changes in activity across all levels of the infant nervous system, including reflex activity, altered brain activity and behaviour, and long-lasting changes in infant physiological stability. A multimodal approach is needed if we are to identify efficacious and well tolerated analgesic treatments. Well designed clinical trials are urgently required to improve analgesic provision in the infant population.
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Hartley C, Duff EP, Green G, Mellado GS, Worley A, Rogers R, Slater R. Nociceptive brain activity as a measure of analgesic efficacy in infants. Sci Transl Med 2018; 9:9/388/eaah6122. [PMID: 28469039 DOI: 10.1126/scitranslmed.aah6122] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 11/30/2016] [Accepted: 03/21/2017] [Indexed: 01/08/2023]
Abstract
Pain in infants is undertreated and poorly understood, representing a major clinical problem. In part, this is due to our inability to objectively measure pain in nonverbal populations. We present and validate an electroencephalography-based measure of infant nociceptive brain activity that is evoked by acute noxious stimulation and is sensitive to analgesic modulation. This measure should be valuable both for mechanistic investigations and for testing analgesic efficacy in the infant population.
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Affiliation(s)
- Caroline Hartley
- Department of Paediatrics, University of Oxford, Oxford OX3 9DU, UK
| | - Eugene P Duff
- Functional Magnetic Resonance Imaging of the Brain Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Gabrielle Green
- Department of Paediatrics, University of Oxford, Oxford OX3 9DU, UK
| | | | - Alan Worley
- Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK
| | - Richard Rogers
- Nuffield Department of Anaesthesia, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Rebeccah Slater
- Department of Paediatrics, University of Oxford, Oxford OX3 9DU, UK.
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Effect of Vibration on Pain Response to Heel Lance: A Pilot Randomized Control Trial. Adv Neonatal Care 2016; 16:439-448. [PMID: 27533335 DOI: 10.1097/anc.0000000000000315] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Applied mechanical vibration in pediatric and adult populations has been shown to be an effective analgesic for acute and chronic pain, including needle pain. Studies among the neonatal population are lacking. According to the Gate Control Theory, it is expected that applied mechanical vibration will have a summative effect with standard nonpharmacologic pain control strategies, reducing behavioral and physiologic pain responses to heel lancing. PURPOSE To determine the safety and efficacy of mechanical vibration for relief of heel lance pain among neonates. METHODS In this parallel design randomized controlled trial, eligible enrolled term or term-corrected neonates (n = 56) in a level IV neonatal intensive care unit were randomized to receive either sucrose and swaddling or sucrose, swaddling, and vibration for heel lance analgesia. Vibration was applied using a handheld battery-powered vibrator (Norco MiniVibrator, Hz = 92) to the lateral aspect of the lower leg along the sural dermatome throughout the heel lance procedure. Neonatal Pain, Agitation, and Sedation Scale (N-PASS) scores, heart rate, and oxygen saturations were collected at defined intervals surrounding heel lancing. RESULTS Infants in the vibration group (n = 30) had significantly lower N-PASS scores and more stable heart rates during heel stick (P = .006, P = .037) and 2 minutes after heel lance (P = .002, P = .016) than those in the nonvibration group. There were no adverse behavioral or physiologic responses to applied vibration in the sample. IMPLICATIONS FOR PRACTICE AND RESEARCH Applied mechanical vibration is a safe and effective method for managing heel lance pain. This pilot study suggests that mechanical vibration warrants further exploration as a nonpharmacologic pain management tool among the neonatal population.
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5
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Pain relief effect of breast feeding and music therapy during heel lance for healthy-term neonates in China: A randomized controlled trial. Midwifery 2015; 31:365-72. [DOI: 10.1016/j.midw.2014.11.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 10/25/2014] [Accepted: 11/01/2014] [Indexed: 11/17/2022]
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6
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Abstract
BACKGROUND Heel lance has been the conventional method of blood sampling in neonates for screening tests. Neonates undergoing heel lance experience pain which cannot be completely alleviated. OBJECTIVES To determine whether venepuncture or heel lance is less painful and more effective for blood sampling in term neonates. SEARCH STRATEGY Randomized or quasi-randomised controlled trials comparing pain response to venepuncture versus heel lance were identified by searching the Cochrane Central Regsiter of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE, EMBASE, CINAHL, and clinical trials registries in May 2011. SELECTION CRITERIA Trials comparing pain response to venepuncture versus heel lance with or with out the use of a sweet tasting solution as a co-intervention in term neonates. DATA COLLECTION AND ANALYSIS Outcomes included pain response to venepuncture versus heel lance with or without the use of a sweet tasting solution using validated pain measures, the need of repeat sampling and cry characteristics. Analyses included typical relative risk (RR), risk difference (RD), number needed to treat (NNT), weighted mean difference (WMD) and standardized mean difference (SMD) with their 95% confidence intervals (CI). Between study heterogeneity was reported including the I squared (I(2)) test. MAIN RESULTS Six studies (n = 478) of variable quality were included. A composite outcome of Infant Pain Scale (NIPS), Neonatal Facial Action Coding System (NFCS) and/or Premature Infant Pain Profile (PIPP) score was reported in 288 infants, who did not receive a sweet tasting solution. Meta-analysis showed a significant reduction in the venepuncture versus the heel lance group (SMD -0.76, 95% CI -1.00 to -0.52; I(2) = 0%). When a sweet tasting solution was provided the SMD remained significant favouring the venepuncture group (SMD - 0.38, 95% CI -0.69 to -0.07). The typical RD for requiring more than one skin puncture for venepuncture versus heel lance (reported in 4 studies; n = 254) was -0.34 (95% CI -0.43 to -0.25; I(2) = 97%). The NNT to avoid one repeat skin puncture was 3 (95% CI 2 to 4). Cry characteristics favoured the venepuncture group but the differences were reduced by the provision of sweet tasting solutions prior to either procedure. AUTHORS' CONCLUSIONS Venepuncture, when performed by a skilled phlebotomist, appears to be the method of choice for blood sampling in term neonates. The use of a sweet tasting solution further reduces the pain.Further well designed randomised controlled trials should be conducted in settings where several individuals perform the procedures.
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Affiliation(s)
- Vibhuti S Shah
- University of TorontoDepartment of Paediatrics and Institute of Health Policy, Management and Evaluation600 University AvenueTorontoONCanadaM5G 1X5
| | - Arne Ohlsson
- University of TorontoDepartments of Paediatrics, Obstetrics and Gynaecology and Institute of Health Policy, Management and EvaluationTorontoCanada
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7
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Patel A, Czerniawski B, Gray S, Lui E. Does topical amethocaine gel reduce pain from heel prick blood sampling in premature infants? A randomized double-blind cross-over controlled study. Paediatr Child Health 2011; 8:222-5. [PMID: 20020001 DOI: 10.1093/pch/8.4.222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Heel prick blood sampling is the most common painful invasive procedure performed on neonates. Currently, there are no effective ways to provide pain relief from this painful procedure. OBJECTIVE To assess the efficacy of the topical anesthetic amethocaine 4% gel (Ametop, Smith & Nephew Inc, St Laurent) in reducing the pain of heel prick blood sampling in neonates. METHODS A randomized, double-blind, placebo controlled, crossover trial was conducted. Neonates between 33 to 37 weeks' gestational age in their first seven days of life were eligible. Heel prick blood sampling was performed on each participant twice. Each infant was randomly assigned to receive either amethocaine 4% gel or placebo to the heel for the first prick, and then received the alternative agent for the second prick. Prick pain was assessed using both Premature Infant Pain Profile (PIPP) and Neonatal Infant Pain Scale (NIPS). Squeeze pain was assessed by NIPS. RESULTS Ten babies were recruited. There were no significant differences in the average PIPP and NIPS scores between the treatment and placebo groups for both prick and squeeze pains from heel prick blood sampling. For prick pain, linear-regression showed significant correlation between the PIPP and NIPS scores. No adverse reactions were observed after application of either the active or placebo agents. CONCLUSION Topical amethocaine 4% gel is not shown to reduce prick and squeeze pains significantly from heel prick blood sampling in neonates between 33 to 37 weeks' gestational age. Further studies are needed to find ways to provide effective pain relief from this common procedure.
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Affiliation(s)
- Amita Patel
- Neonatal Intensive Care Unit, McMaster Children's Hospital, Hamilton
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8
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Okan F, Ozdil A, Bulbul A, Yapici Z, Nuhoglu A. Analgesic effects of skin-to-skin contact and breastfeeding in procedural pain in healthy term neonates. ACTA ACUST UNITED AC 2010; 30:119-28. [PMID: 20522298 DOI: 10.1179/146532810x12703902516121] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The effectiveness of skin-to-skin contact to decrease pain from heel-lancing in healthy term neonates and whether breastfeeding in addition to skin-to-skin contact provided a more effective analgesia than skin-to-skin contact alone were investigated. METHODS A randomised, controlled trial was conducted in 107 neonates undergoing heel-lance. Infants were randomly assigned to three groups: (i) being breastfed with skin-to-skin contact (group 1, n=35), (ii) being held in their mother's arms with skin-to-skin contact but no breastfeeding (group 2, n=36), or (iii) lying on the table before, during and after painful stimulus (group 3, n=36). Physiological responses to pain were measured by heart rate and oxygen saturation changes and behavioural responses were measured by duration of crying and grimacing. RESULTS Infants had a mean (SD) birthweight of 3355 (270) g and gestational age of 39.5 (0.6) weeks; at the time of the procedure, mean (SD) postnatal age was 33.1 (5) hours. There was no significant difference between the groups in clinical characteristics and time spent squeezing the heel. Heart rate, oxygen saturation changes and length of crying were significantly reduced in groups 1 and 2 compared with group 3 (p<0.001). No difference was found between group 1 and group 2. Grimacing was less in group 2 than in group 3 (p<0.001). CONCLUSIONS In healthy term neonates, skin-to-skin contact with the mother and breastfeeding with skin-to-skin contact reduce both physiological and behavioural pain response. Breastfeeding in the 1st 2 postnatal days with skin-to-skin contact did not increase the analgesic effect of skin-to-skin contact alone.
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Affiliation(s)
- F Okan
- Department of Pediatrics, Sisli Children's Hospital, Istanbul
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9
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Abstract
OBJECTIVE To assess the use of analgesia guidelines for newborn infants in the United Kingdom. STUDY DESIGN Postal questionnaire to every neonatal unit in the United Kingdom. RESULT A total of 192 of 244 units replied (78.7% response). Most units had a guideline for elective intubation (70%), sedation for ventilation (78%) post-operative pain (when appropriate) (74%). Less prevalent were guidelines for painful minor procedures (35%). Only 33% of units gave a sweet-tasting solution for analgesia before routine painful procedures and 12% used a topical anesthetic cream. CONCLUSION Since the last survey in 2000 there has been a modest increased uptake in measures to prevent pain neonatal pain in the United Kingdom, but no pain guideline was present in almost 25% of units and no guideline for routine painful procedures in the majority.
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Affiliation(s)
- L McKechnie
- Department of Neonatology, St James University Hospital, Leeds, UK.
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10
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Abstract
BACKGROUND Heel lance has been the conventional method of blood sampling in neonates for screening tests. Neonates undergoing this procedure experience pain. Despite various studies evaluating the role of pharmacological and non-pharmacological interventions to date, there are no effective and practical methods to alleviate pain from heel lance. OBJECTIVES To determine whether venepuncture or heel lance is less painful and more effective for blood sampling in term neonates. SEARCH STRATEGY Systematic search was performed in accordance with the Cochrane Neonatal Collaborative Review Group. Randomized controlled trials which compared pain response to venepuncture vs. heel lance were identified using MEDLINE (1966 - June 2007), EMBASE (1980 - June 2007), CINAHL (1982 - June 2007), Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2007), reference lists of identified trials and personal files. No language restrictions were applied. SELECTION CRITERIA Randomized controlled trials which compared pain response to venepuncture vs. heel lance were selected for this review. DATA COLLECTION AND ANALYSIS Data regarding the primary outcome of pain response to venepuncture vs. heel lance as assessed by validated pain measures were abstracted. Secondary outcomes included the need of repeat blood sampling, bruising/hematoma at local site, and parental perception of their own anxiety and infant's pain. All data were analysed using RevMan 4.2.10. When possible, meta-analyses were performed using relative risk (RR) and risk difference (RD), along with their 95% confidence intervals (CI). If RD was significant, number needed to treat (NNT) was calculated. Weighted mean difference (WMD) was used for continuous data. When present, statistically significant between study heterogeneity was reported including the I squared (I(2) ) test. MAIN RESULTS Five trials were eligible for inclusion in the review (including one additional trial identified in this update). Pain assessments were made using validated pain measures including Neonatal Infant Pain Scale (NIPS), Neonatal Facial Action Coding System (NFCS), Premature Infant Pain Profile (PIPP) score and cry characteristics. Two trials did not report on outcomes for all enrolled infants (not intention to treat analyses). Despite the many different pain measures used, all studies showed statistically significantly lower pain scores for venepuncture as compared to heel lance. A meta-analysis of the NIPS scores during the first minute of the procedure (reported in two studies) was statistically significantly lower in the venepuncture group compared to the heel lance group [typical WMD -1.84 (95% CI -2.61, -1.06)]. There was no statistically significant heterogeneity for this outcome (p = 0.22; I(2) 33.3%). The typical RR for requiring more than one skin puncture for venepuncture vs. heel lance (reported in 4 studies) was 0.30 (95% CI 0.18, 0.49). The RD was -0.31 (95% CI -0.41, -0.22). For this outcome there was statistically significant between study heterogeneity (for RR, p = 0.02, I(2 )74.3%; for RD, p < 0.00001, I(2) 96.6%). The number needed to treat (NNT) to avoid one repeat skin puncture was 3 (95% CI 2, 5). In one study, maternal anxiety was noted to be higher in the venepuncture group as compared to heel lance group prior to the procedure; however, after observing the procedure, mothers rated their infant's pain to be lower in the venepuncture group. AUTHORS' CONCLUSIONS Venepuncture, when performed by a skilled phlebotomist, appears to be the method of choice for blood sampling in term neonates. For each three venepunctures instead of heel lance, the need for one additional skin puncture can be avoided.Further well designed randomized controlled trials need to be conducted. The interventions should be compared in settings where several individuals perform the venepuncture and/or the heel lance.
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Affiliation(s)
- V Shah
- Mount Sinai Hospital, Department of Paediatrics, Room 775A, 600 University Avenue, Toronto, Ontario, Canada, M5G 1X5.
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11
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Abstract
During the past two decades there has been a substantial increase in the number and types of topical anesthetics available. Options for the prevention of neonatal pain associated with skin-breaking procedures were previously limited to injections of lidocaine hydrochloride. Topical anesthetics are now available as creams, gels, and a heat-activated patch system. Although lidocaine injection continues to be widely used for pain associated with circumcision, lumbar puncture, or placement of central venous lines, practical information regarding the use of newer agents in the neonate is needed. This review seeks to expand the options for topical anesthesia in neonates.
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Affiliation(s)
- Victoria Tutag Lehr
- Department of Pharmacy Practice, The Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Division of Clinical Pharmacology & Toxicology, Children's Hospital of Michigan, Detroit, MI, USA
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12
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Abstract
Venipuncture is now the standard method of phlebotomy for well newborn infants at Kingston General Hospital (KGH), Canada. Newborn infants require at least one blood sample for mandatory genetic screening. Some will require additional samples for monitoring of hyperbilirubinemia or other laboratory tests. A change from capillary heel sticks to venipuncture was implemented when the lancets in use were discontinued and a suitable replacement could not be found at the time. A review of the literature discovered a Cochrane Neonatal Review that supported newborn venipuncture as a safe, pain-reducing practice when performed by trained phlebotomists. As a result, a quality improvement project was developed to implement the practice of venipuncture for the well newborn. The implementation and evaluation included lectures, demonstrations, return demonstrations, and eventual integration into clinical practice. Process and summative evaluation demonstrated a willingness of staff to learn a new procedure, particularly when they had identified the need for change. In addition, infants were not subjected to multiple, ineffective blood draws.
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13
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Abstract
The prevention of pain in neonates should be the goal of all caregivers, because repeated painful exposures have the potential for deleterious consequences. Neonates at greatest risk of neurodevelopmental impairment as a result of preterm birth (ie, the smallest and sickest) are also those most likely to be exposed to the greatest number of painful stimuli in the NICU. Although there are major gaps in our knowledge regarding the most effective way to prevent and relieve pain in neonates, proven and safe therapies are currently underused for routine minor yet painful procedures. Every health care facility caring for neonates should implement an effective pain-prevention program, which includes strategies for routinely assessing pain, minimizing the number of painful procedures performed, effectively using pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures, and eliminating pain associated with surgery and other major procedures.
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14
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Sato Y, Fukasawa T, Hayakawa M, Yatsuya H, Hatakeyama M, Ogawa A, Kuno K. A new method of blood sampling reduces pain for newborn infants: a prospective, randomized controlled clinical trial. Early Hum Dev 2007; 83:389-94. [PMID: 16979855 DOI: 10.1016/j.earlhumdev.2006.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Revised: 08/08/2006] [Accepted: 08/10/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND Using a new simple blood glucose measurement device (Free Style), blood can thus be sampled from the forearm, which is less sensitive to pain than from the heel. Measuring the blood glucose levels in newborn infants using Free Style is therefore a potentially less painful testing modality than traditional blood sampling methods. OBJECTIVE To compare the pain intensity at the time of blood sampling from the forearm using the Free Style with the conventional method from the heel. DESIGN A prospective, randomized controlled clinical trial. PATIENTS AND METHODS Sixty healthy neonates were randomized by the sealed envelope method into two groups-Group F, in which blood was sampled from the forearm using the Free Style, and Group H, in which blood was conventionally sampled from the heel using a lancet. The pain intensity was assessed based on their crying, the Neonatal Facial Coding System (NFCS) and the Neonatal Infant Pain Scale (NIPS). RESULTS After skin puncture, 12 (40%) of the infants cried in Group F and 27 (90%) in Group H. The duration of crying was also significantly shorter in Group F than in Group H. Both of pain scores between the two groups differed significantly, these findings indicated less pain for Group F. CONCLUSION The new blood sampling method from the forearm was found to be less painful than the conventional method, thus making it possible to clinically use this product as an innovative method for blood sampling in neonatal medicine.
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Affiliation(s)
- Yoshiaki Sato
- Department of Pediatrics, Anjo Kosei Hospital, Anjo, Aichi, Japan.
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15
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Lemyre B, Hogan DL, Gaboury I, Sherlock R, Blanchard C, Moher D. How effective is tetracaine 4% gel, before a venipuncture, in reducing procedural pain in infants: a randomized double-blind placebo controlled trial. BMC Pediatr 2007; 7:7. [PMID: 17288611 PMCID: PMC1800845 DOI: 10.1186/1471-2431-7-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Accepted: 02/08/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Procedural pain relief is sub-optimal in neonates. Topical tetracaine provides pain relief in children. Evidence of its efficacy and safety in neonates is limited. The objective of this study was to assess the efficacy and safety of topical tetracaine on the pain response of neonates during a venipuncture. METHODS Medically stable infants greater than or equal to 24 weeks gestation, requiring a venipuncture, were included. Following randomization and double blinding, 1.1 g of tetracaine or placebo was applied to the skin for 30 minutes. Participants received oral sucrose if they met local eligibility criteria. The venipuncture was performed according to a standard protocol. A medium effect size in the pain score (corresponding to about 2 point difference in the PIPP score) was considered clinically significant, leading to a sample size of 142 infants, with 80% statistical power. Local skin reactions and immediate adverse cardiorespiratory events were noted. The primary outcome, PIPP score at 1 minute, was analysed using an independent Student's t-test. RESULTS One hundred and forty two infants were included, 33 +/- 4 weeks gestation, 2100 +/- 900 grams and 6 +/- 3 days of age. There was almost no difference in PIPP scores at 1 minute between groups (mean difference -0.09; 95% confidence interval [CI]: -1.68 to 1.50; P = . 91). Similarly, there were no differences in PIPP scores during the 2nd, 3rd and 4th minute. Duration of cry did not differ between the groups (median difference, 0; 95% CI, -3 to 0; P = . 84). The majority of infants in both groups received sucrose 24%. Sucrose had a significant effect on the PIPP score, as assessed by an ANOVA model (p = 0.0026). Local skin erythema was observed transiently in 11 infants (7 in the tetracaine and 4 in the placebo group). No serious side effect was observed. CONCLUSION Tetracaine did not significantly decrease procedural pain in infants undergoing a venipuncture, when used in combination with routine sucrose administration.
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Affiliation(s)
- Brigitte Lemyre
- Department of Pediatrics, University of Ottawa, Ottawa, Canada
| | - Debora L Hogan
- Department of Nursing, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Isabelle Gaboury
- Chalmers Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Rebecca Sherlock
- Department of Pediatrics, BC Children's and Women's Health Center, Vancouver, Canada
- Department of Healthcare and Epidemiology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Colline Blanchard
- Department of Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - David Moher
- Department of Pediatrics, University of Ottawa, Ottawa, Canada
- Chalmers Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- Department of Epidemiology & Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
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16
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Abstract
The prevention of pain in neonates should be the goal of all caregivers, because repeated painful exposures have the potential for deleterious consequences. Neonates at greatest risk of neurodevelopmental impairment as a result of preterm birth (ie, the smallest and sickest) are also those most likely to be exposed to the greatest number of painful stimuli in the NICU. Although there are major gaps in our knowledge regarding the most effective way to prevent and relieve pain in neonates, proven and safe therapies are currently underused for routine minor yet painful procedures. Every health care facility caring for neonates should implement an effective pain-prevention program, which includes strategies for routinely assessing pain, minimizing the number of painful procedures performed, effectively using pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures, and eliminating pain associated with surgery and other major procedures.
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17
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Taddio A, Lee CM, Parvez B, Koren G, Shah V. Contact dermatitis and bradycardia in a preterm infant given tetracaine 4% gel. Ther Drug Monit 2006; 28:291-4. [PMID: 16778708 DOI: 10.1097/01.ftd.0000195615.92591.9c] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The use of analgesics for procedural pain management in the newborn infant has been steadily increasing during the past decade. With this trend of increased analgesic utilization, there is the potential for infants to suffer from drug-induced side effects. There also is the potential to wrongfully blame drugs for all adverse events that occur during analgesic use. Two adverse events that occurred in a neonate exposed to tetracaine gel and the probability that the adverse events were caused by the drug are presented. During administration of the topical local anesthetic tetracaine for analgesia during percutaneous central venous catheter placement, a preterm infant experienced bradycardia. Several hours later, a local cutaneous reaction that progressed to skin desquamation occurred at the site. The authors assessed the probability that tetracaine caused 2 adverse events using a validated adverse drug reaction probability scale by Naranjo et al. According to the algorithm developed by Naranjo et al, it was determined that bradycardia was unlikely caused by the drug; however, the dermal reaction was probably the result of the drug.The authors determined that tetracaine caused a serious local skin reaction, but not bradycardia, in a preterm infant. This is the first report of a serious skin reaction in a neonate treated with tetracaine. Based on these findings, tetracaine gel can continue to be used to treat pain in neonates with careful evaluation of the skin.
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Affiliation(s)
- Anna Taddio
- Department of Pharmacy and Population Health Sciences, The Hospital for Sick Children, Toronto, Canada.
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Anand KJS, Johnston CC, Oberlander TF, Taddio A, Lehr VT, Walco GA. Analgesia and local anesthesia during invasive procedures in the neonate. Clin Ther 2006; 27:844-76. [PMID: 16117989 DOI: 10.1016/j.clinthera.2005.06.018] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2005] [Indexed: 11/30/2022]
Abstract
BACKGROUND Preterm and full-term neonates admitted to the neonatal intensive care unit or elsewhere in the hospital are routinely subjected to invasive procedures that can cause acute pain. Despite published data on the complex behavioral, physiologic, and biochemical responses of these neonates and the detrimental short- and long-term clinical outcomes of exposure to repetitive pain, clinical use of pain-control measures in neonates undergoing invasive procedures remains sporadic and suboptimal. As part of the Newborn Drug Development Initiative, the US Food and Drug Administration and the National Institute of Child Health and Human Development invited a group of international experts to form the Neonatal Pain Control Group to review the therapeutic options for pain management associated with the most commonly performed invasive procedures in neonates and to identify research priorities in this area. OBJECTIVE The goal of this article was to review and synthesize the published clinical evidence for the management of pain caused by invasive procedures in preterm and full-term neonates. METHODS Clinical studies examining various therapies for procedural pain in neonates were identified by searches of MEDLINE (1980-2004), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 1, 2004), the reference lists of review articles, and personal files. The search terms included specific drug names, infant-newborn, infant-preterm, and pain, using the explode function for each key word. The English-language literature was reviewed, and case reports and small case series were discarded. RESULTS The most commonly performed invasive procedures in neonates included heel lancing, venipuncture, IV or arterial cannulation, chest tube placement, tracheal intubation or suctioning, lumbar puncture, circumcision, and SC or IM injection. Various drug classes were examined critically, including opioid analgesics, sedative/hypnotic drugs, nonsteroidal anti-inflammatory drugs and acetaminophen, injectable and topical local anesthetics, and sucrose. Research considerations related to each drug category were identified, potential obstacles to the systematic study of these drugs were discussed, and current gaps in knowledge were enumerated to define future research needs. Discussions relating to the optimal design for and ethical constraints on the study of neonatal pain will be published separately. Well-designed clinical trials investigating currently available and new therapies for acute pain in neonates will provide the scientific framework for effective pain management in neonates undergoing invasive procedures.
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Affiliation(s)
- K J S Anand
- Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, USA.
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Lemyre B, Sherlock R, Hogan D, Gaboury I, Blanchard C, Moher D. How effective is tetracaine 4% gel, before a peripherally inserted central catheter, in reducing procedural pain in infants: a randomized double-blind placebo controlled trial [ISRCTN75884221]. BMC Med 2006; 4:11. [PMID: 16672064 PMCID: PMC1468422 DOI: 10.1186/1741-7015-4-11] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Accepted: 05/03/2006] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Procedural pain relief is sub-optimal in infants, especially small and vulnerable ones. Tetracaine gel 4% (Ametop, Smith-Nephew) provides pain relief in children and larger infants, but its efficacy in smaller infants and for peripherally inserted central catheters (PICC) remains uncertain. The objective of this trial was to assess the safety and efficacy of tetracaine gel on the pain response of very low birth weight (VLBW) infants during insertion of a PICC. METHODS Medically stable infants greater than or equal to 24 weeks gestation, requiring a non-urgent PICC, were included. Following randomization and double blinding, 1.1 g of tetracaine or placebo was applied to the skin for 30 minutes. The PICC was inserted according to a standard protocol. Pain was assessed using the Premature Infant Pain Profile (PIPP). A 3-point change in the pain score was considered clinically significant, leading to a sample size of 54 infants, with 90% statistical power. Local skin reactions and immediate adverse cardiorespiratory events were noted. The primary outcome, PIPP score at 1 minute, was analysed using an independent Student's t-test. RESULTS Fifty-four infants were included, 27 +/- 2 weeks gestation, 916 +/- 292 grams and 6.5 +/- 3.2 days of age. Baseline characteristics were similar between groups. The mean PIPP score in the first minute was 10.88 in the treatment group as compared to 11.74 in the placebo group (difference 0.86, 95% CI -1.86, 3.58). Median duration of crying in non-intubated infants was 181 seconds in the tetracaine group compared to 68 seconds in the placebo group (difference -78, 95% CI -539, 117). Local skin erythema was observed transiently in 4 infants (3 in the treatment and 1 in the placebo group). No serious harms were observed. CONCLUSION Tetracaine 4% when applied for 30 minutes was not beneficial in decreasing procedural pain associated with a PICC in very small infants.
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Affiliation(s)
- Brigitte Lemyre
- Department of Pediatrics, Children's Hospital of Eastern Ontario, 401, Smyth Road, Ottawa, Ontario, Canada
| | - Rebecca Sherlock
- Department of Pediatrics, BC Children's and Women's Health Center, 4480, Oak Street, Vancouver, BC, Canada
| | - Debora Hogan
- Department of Nursing, Hospital of Eastern Ontario, 401, Smyth Road, Ottawa, Ontario, Canada
| | - Isabelle Gaboury
- Chalmers Research Group, Children's Hospital of Eastern Ontario Research Institute, 401, Smyth Road, Ottawa, Ontario, Canada
| | - Colline Blanchard
- Department of Pharmacy, Children's Hospital of Eastern Ontario, 401, Smyth Road, Ottawa, Ontario, Canada
| | - David Moher
- Department of Pediatrics, Children's Hospital of Eastern Ontario, 401, Smyth Road, Ottawa, Ontario, Canada
- Chalmers Research Group, Children's Hospital of Eastern Ontario Research Institute, 401, Smyth Road, Ottawa, Ontario, Canada
- Department of Epidemiology & Community Medicine, Faculty of Medicine, University of Ottawa, Canada
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Tadicherla S, Berman B. Percutaneous dermal drug delivery for local pain control. Ther Clin Risk Manag 2006; 2:99-113. [PMID: 18360585 PMCID: PMC1661648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Topical anesthetics have evolved from a simple solution of cocaine to creams, ointments, gels, liposomal preparations, and to the latest sophisticated patches and peels. Topical anesthetics are essential for performing diagnostic, therapeutic, and cosmetic dermatology procedures. These anesthetics noninvasively deliver anesthesia in locally required areas. In this review, we present an overview on the mechanism of precutaneous absorption of skin and address the composition, duration of onset of anesthetic effect, uses, and side effects that are applicable for the products. Also discussed are the novel advances of using heat to enhance penetration of the anesthetic as seen in Synera(trade mark) patch and delivery of anesthesia using a peel method as seen in the yet to be US Food and Drug Administration-approved S-Caine peel.
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Affiliation(s)
- Sujatha Tadicherla
- Department of Dermatology and Cutaneous Surgery, University of Miami Miami, FL, USA
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O'Brien L, Taddio A, Lyszkiewicz DA, Koren G. A critical review of the topical local anesthetic amethocaine (Ametop) for pediatric pain. Paediatr Drugs 2005; 7:41-54. [PMID: 15777110 DOI: 10.2165/00148581-200507010-00004] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
A topical formulation of the ester-type local anesthetic amethocaine (tetracaine) [Ametop ] is currently available for reducing pain from cutaneous procedures such as venipuncture. The Ametop mark preparation contains 40 mg of amethocaine base (4% w/w) and produces anesthesia within 30-45 minutes of application; duration of action ranges from 4 to 6 hours. Clinical studies have demonstrated the superiority of the 4% amethocaine preparation over placebo in pediatric populations for indications such as intravenous cannulation, vaccination, and venipuncture. Amethocaine has been shown to produce anesthesia comparable to that of 5% lidocaine-prilocaine for procedures such as venipuncture and accessing centrally placed devices; in general, anesthesia was achieved more rapidly with amethocaine than lidocaine-prilocaine. In the neonatal population amethocaine was found to be ineffective at reducing the pain of heel prick and peripherally inserted central catheters. Depending on the type of procedure, amethocaine application times between 30 and 60 minutes have produced clinically acceptable anesthesia; application times <30 minutes have not been associated with reliable anesthesia. The 4% amethocaine preparation is well tolerated; the most commonly reported local skin reaction is transient local erythema while local edema and itching have been reported more rarely. There have been no accounts of systemic toxicity with topical use of the preparation. Several cases of sensitization have been described in adults upon repeated exposure to topical amethocaine. In summary, the novel preparation of 4% amethocaine gel has been shown to be clinically effective for managing pain associated with minor cutaneous procedures while maintaining a good tolerability profile. Amethocaine has also demonstrated similar efficacy to lidocaine-prilocaine when appropriate application times are used; the more rapid onset of action and extended duration of action of amethocaine may make it more useful than lidocaine-prilocaine in busy clinical settings.
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Affiliation(s)
- Lisa O'Brien
- Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, Ontario, Canada
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Abstract
BACKGROUND Heel lance has been the conventional method of blood sampling in neonates for screening tests. Neonates undergoing this procedure experience pain. Despite various studies evaluating the role of pharmacological and non-pharmacological interventions to date, there are no effective and practical methods to alleviate pain from heel lance. OBJECTIVES To determine whether venepuncture or heel lance is less painful and more effective for blood sampling in term neonates. SEARCH STRATEGY Systematic search in accordance with the Cochrane Neonatal Collaborative Review Group. All randomized controlled trials which compared pain response to venepuncture vs. heel lance were identified using MEDLINE (1966-June 2004), EMBASE (1980-June 2004), CINAHL (1982-June 2004, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2004), reference lists of identified trials and personal files. No language restrictions were applied. SELECTION CRITERIA Randomized controlled trials which compared pain response to venepuncture vs. heel lance were selected for this review. DATA COLLECTION AND ANALYSIS Data regarding the primary outcome of pain response to venepuncture vs. heel lance as assessed by validated pain measures were abstracted. Secondary outcomes including the need of repeat blood sampling, bruising/hematoma at local site, and parental perception of their own anxiety and infant's pain were abstracted. All data were analysed using RevMan 4.2. When possible, meta-analysis was done using relative risk (RR) and risk difference (RD), along with their 95% confidence intervals (CI). If RD was significant, number needed to treat (NNT) was calculated. Weighted mean difference (WMD) was used for continuous data. When present, statistically significant between study heterogeneity was reported including the I(2) test. MAIN RESULTS Four trials were eligible for inclusion in the review. Pain assessments were made using validated pain measures including Neonatal Infant Pain Scale (NIPS), Neonatal Facial Action Coding System (NFCS), Premature Infant Pain Profile (PIPP) score and cry characteristics. Two trials did not report on outcomes for all enrolled infants (not intention to treat analyses). Despite the heterogeneity in the pain measures used, all studies showed statistically significantly lower pain scores for venepuncture as compared to heel lance. A meta-analysis of the NIPS scores during the first minute of the procedure (reported in two studies) was statistically significantly decreased in the VP group compared to the HL group [WMD -1.84 (95% CI -2.61, -1.06)]. There was no statistically significant heterogeneity for this outcome (p = 0.22; I(2) 33.3%). The RR for requiring more than one skin puncture for venepuncture vs. heel lance (reported in 3 studies) was 0.30 (95% CI 0.18, 0.49. The risk difference was -39% (95% CI -50%, -28%). For this outcome there was statistically significant between study heterogeneity (for RR, p=0.02, I(2 )74.3%; for RD, p=0.0001, I(2) 88.9%). The number needed to treat (NNT) to avoid one repeat skin puncture was 3 (95% CI 2, 4). In one study, maternal anxiety was noted to be higher in the venepuncture group as compared to heel lance group prior to the procedure; however, after observing the procedure, mothers rated their infant's pain to be lower in the venepuncture group. REVIEWERS' CONCLUSIONS Venepuncture, when performed by a skilled phlebotomist, appears to be the method of choice for blood sampling in term neonates. For each three venepunctures instead of heel lance, the need for one additional skin puncture can be avoided. Further well designed randomized controlled trials need to be conducted. The interventions should be compared in settings where several individuals perform the venepuncture and/or the heel lance.
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Affiliation(s)
- V Shah
- Department of Paediatrics, Mount Sinai Hospital, Room 775A, 600 University Avenue, Toronto, Ontario, Canada, M5G 1X5
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Jöhr M, Berger TM. Regional anaesthetic techniques for neonatal surgery: indications and selection of techniques. Best Pract Res Clin Anaesthesiol 2004; 18:357-75. [PMID: 15171509 DOI: 10.1016/j.bpa.2003.11.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The goal of neonatal care is to optimise the outcome of term and preterm infants with minimal suffering. Neonates are rare patients for the anaesthetist, therefore personal and even global experiences are limited. This chapter focuses on strategies for dealing with common clinical situations, e.g. heel lancing, obtaining vascular access, circumcision, hernia repair and pyloric stenosis, as well as major neonatal surgery. With the exception of heel lancing, regional techniques are useful in all cases. However, a careful risk-benefit analysis is mandatory, especially when considering more invasive techniques such as epidural catheters.
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Affiliation(s)
- Martin Jöhr
- Department of Anaesthesia, Kantonsspital, CH-6000, Luzern 16, Switzerland.
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Ballantyne M, McNair C, Ung E, Gibbins S, Stevens B. A randomized controlled trial evaluating the efficacy of tetracaine gel for pain relief from peripherally inserted central catheters in infants. Adv Neonatal Care 2003; 3:297-307. [PMID: 14695501 DOI: 10.1016/j.adnc.2003.09.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Insertion of peripherally inserted central catheters (PICC) is a commonly performed procedure in both preterm and term infants. Tetracaine 4% gel (Ametop; Smith & Nephew Inc, St. Laurent, Quebec), a topical anesthetic, although reported to be effective for reducing the pain of venipuncture in neonates, has not been investigated for the management of pain associated with the PICC procedure. PURPOSE To determine the efficacy of tetracaine gel for managing the pain associated with the PICC procedure in preterm and term infants. METHODS A double-blind, placebo-controlled, randomized controlled trial (RCT) design was used. Infants undergoing nonurgent PICC insertion were randomized to receive either the treatment (1.0 g of tetracaine 4% gel) or placebo control (1.0 g of eucerin-plus cream) applied to the skin under occlusion for 30 minutes before the procedure. Data on the behavioral (facial expression) and physiologic (heart rate and oxygen saturation) indicators of pain were collected via videotaping and computer monitoring throughout the procedure. Data then were coded and measured by independent observers using the Premature Infant Pain Profile (PIPP; Stevens et al, 1996), and analyzed using descriptive statistics and repeated-measures analyses of variance. RESULTS Forty-nine infants, gestational age 27 to 41 weeks (mean = 33; SD = 4.2) and age at time of insertion 2 to 85 days (mean = 18; SD = 22.5) participated. No differences were found between the groups at the time of randomization. There were no adverse cardiorespiratory events or local skin reactions in either group. There was a significant within-subjects main effect of time across the procedure (F[48,3] = 11.03; P < 0.0001). There was no significant between-subjects main effect of group (F[48,1] = 0.11; P = 0.74) and no (group x time) interaction (F[48,3] = 0.45; P = 0.72). CONCLUSION Tetracaine gel was not effective for pain relief for PICC insertion in infants. Its use for pain relief cannot be recommended based on the results of this study. Other pharmacologic, behavioral, and physical interventions should be investigated for safety and relief of procedural pain in this population of infants.
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Long CP, McCafferty DF, Sittlington NM, Halliday HL, Woolfson AD, Jones DS. Randomized trial of novel tetracaine patch to provide local anaesthesia in neonates undergoing venepuncture. Br J Anaesth 2003; 91:514-8. [PMID: 14504152 DOI: 10.1093/bja/aeg216] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Procedures such as venepuncture or heel prick are painful and may cause considerable stress to newborn infants. Topical local anaesthetics are effective for venepuncture but need to be applied for at least 60 min and the delivered dose will vary. We assessed a novel tetracaine-based self-adhesive patch in providing controlled local anaesthesia before venepuncture. METHODS A placebo-controlled, double-blind trial was conducted using a tetracaine patch formulated from hydroxypropylcellulose discs (0.283 cm(2)) containing tetracaine (1 mg x cm(-2)) surrounded by a low tack pressure-sensitive adhesive backing layer. Thirty-two newborn infants of gestation 32-42 weeks (median 36 weeks), aged 3-18 days (median 6 days) were randomized to receive a tetracaine-containing patch or a placebo device applied to the dorsum of the hand 30 min before venepuncture to obtain blood samples. Pain was assessed in response to needle insertion using a validated adaptation of the neonatal facial coding score (NFCS) and the presence of crying. RESULTS Of 15 tetracaine-treated neonates, 14 (93%) presented little or no pain in response to the procedure compared with six of 17 (35%) who had the placebo patch applied (P=0.01). CONCLUSIONS The tetracaine patch produced effective pain relief during the venepuncture procedure in both term and pre-term infants. There were no adverse effects, either local or systemic.
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Affiliation(s)
- C P Long
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK.
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Abstract
Newborn care in the first 24 hours of life has been based on tradition for many years. Nurses recognize that many practices are not based on good scientific evidence and are not individualized. Instead, all newborns are treated as though they acquire potential pathogens during birth and are oblivious to noxious interventions such as intramuscular injections and heel sticks. In this article, obtaining blood samples from heel sticks and administering vitamin K and prophylaxis for ophthalmia neonatorum are presented as practices that require scrutiny by nurses to promote evidence-based care of newborns in the 1st day of life.
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Affiliation(s)
- Jennifer M Medves
- School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.
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