Neonatal pain article.pdf - Original Research Donna Dowling PhD RN \u274d Section Editor 2.5 HOURS Continuing Education Effect of Vibration on Pain

Neonatal pain article.pdf - Original Research Donna Dowling...

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Copyright © 2016 National Association of Neonatal Nurses. Unauthorized reproduction of this article is prohibited. 439 Original Research Donna Dowling, PhD, RN Section Editor Advances in Neonatal Care • Vol. 16, No. 6 • pp. 439-448 I nfants hospitalized in the neonatal intensive care unit (NICU) are often exposed to repeated, painful procedures that are medically necessary, yet carry adverse short- and long-term effects. 1 Neonates born extremely premature have intact nociception, but are limited in their ability to communicate pain. 2 Pain thresholds of neonates are lower when compared with children and adults because of immature descending inhibitory pathways and lower tactile thresholds prone to further sensitization, 3-6 making neonates uniquely vulnerable to the detrimental effects of pain. Infants who are born very premature often experience more than 100 skin-breaking procedures during their NICU hospitalization. 7 Pain exposure, even after Effect of Vibration on Pain Response to Heel Lance A Pilot Randomized Control Trial Kate McGinnis, MSN, NNP-BC; Eileen Murray, RNC-NIC; Brooke Cherven, RN, MPH, CPON; Courtney McCracken, PhD; Curtis Travers, MPH ABSTRACT Background: Applied mechanical vibration in pediatric and adult populations has been shown to be an effective analge- sic 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 nonphar- macologic 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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