Positioning Effects for Procedural Pain Relief in NICU: Systematic Review

Francisco, Anilsa Suraya Pedro Gaspar; Montemezzo, Dayane; Ribeiro, Simone Nascimento Santos; Frata, Bruna; Menegol, Natália Alves; Okubo, Rodrigo; Sonza, Anelise; Sanada, Luciana Sayuri

doi:10.1016/j.pmn.2020.07.006

Cited by 11 publications

(24 citation statements)

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“…After removing 116 duplicates, the titles and abstracts of 215 papers were reviewed for eligibility. A total of 172 articles were excluded, leaving 43 full-text screening of which 29 articles met the inclusion criteria and were included in this overview 23–51 Online supplemental appendix 3 table 1. lists the reasons for the exclusion of 14 studies.…”

Section: Resultsmentioning

confidence: 99%

“…Eighteen SRs included RCTs only,26–28 31–33 35–39 41 42 44 45 47 49 50 while the other reviews included non-RCTs, case studies and descriptive studies. Regarding the participants, 10 SRs were specific to preterm infants,26 27 31–33 37 39 40 42 43 1 SR was directed at term neonates30 and the other 18 SRs included both term and preterm neonates 23–25 28 29 34–36 38 41 44–51. The types of pain involved in the included SRs consisted of postoperative pain (3.4%), single procedural pain (89.7%) and repeated procedural pain (6.9%).…”

Section: Resultsmentioning

confidence: 99%

“… 53 It was mentioned in a systematic review that facilitated tucking by parents (FTP) was the best position for procedural pain relief in preterm infants. 25 The authors recommended that FTP in side-lying be administered from 15 min before the beginning of the painful procedures to 15 min after the painful stimuli. 25 One advantage of FT is that parents or health professionals can easily learn and perform it because of its minimal technical challenges.…”

Section: Discussionmentioning

confidence: 99%

“… 25 The authors recommended that FTP in side-lying be administered from 15 min before the beginning of the painful procedures to 15 min after the painful stimuli. 25 One advantage of FT is that parents or health professionals can easily learn and perform it because of its minimal technical challenges. 54 Another advantage is that it is effective for extremely or very premature infants without requiring any other abilities, such as mature sucking ability.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of non-pharmacological interventions for neonatal pain: an overview of systematic reviews

et al. 2022

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ObjectivesTo synthesise current evidence from systematic reviews (SRs) regarding the efficacy and safety of non-pharmacological interventions to prevent and treat pain in newborn infants.DesignOverview of SRs.Data sourcesWe searched PubMed, Embase, Cochrane Library, Web of Science, CINAHL, Chinese National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Wanfang Database, Chinese Science and Technology Periodical Database (VIP) and Google Scholar to identify all relevant SRs published in the last 5 years.Eligibility criteria for selecting studiesWe included SRs that evaluated the efficacy and safety of non-pharmacological interventions for neonatal pain.Data extraction and synthesisTwo reviewers independently extracted the data, assessed the methodological quality using a Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 and graded the evidence quality with the Grading of Recommendations Assessment, Development and Evaluation (GRADE).ResultsA total of 29 SRs were included in this overview, of which 28 focused on procedural pain and only 1 focused on postoperative pain. Based on AMSTAR 2, seven reviews were found to be of ‘high quality‘, eight of ‘moderate quality’, five of ‘low quality’ and nine of ‘critically low quality’. The GRADE results suggested that facilitated tucking, kangaroo care, sweet solutions, familiar odour or combined non-pharmacological interventions, such as a combination of sucrose and non-nutritive sucking, were effective and safe in reducing pain from medical procedures in neonates. However, sucrose alone was less effective than local anaesthesia or a combination of the two during circumcision.ConclusionsFacilitated tucking, small volumes of sweet solutions, kangaroo care and familiar odour were recommended. Scientific implementation strategies should be developed to promote the clinical use of these effective non-pharmacological interventions. Meanwhile, further rigorous trials and SRs are needed to identify the best non-pharmacological approaches for pain from common surgery and illnesses in neonates.PROSPERO registration numberCRD42021292583.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of non-pharmacological interventions for neonatal pain: an overview of systematic reviews

et al. 2022

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“…In addition, a recent systematic review of 20 studies investigating different positions for procedural pain relief (mostly during heel lances) concluded that different positioning in the incubator or the crib (prone, lateral, or supine positions) has minimal analgesic effects and, therefore, should not be used as analgesic strategies in neonatal intensive care units, considering the evidence of more effective nonpharmacological interventions. 13 In terms of analgesic mechanisms of action, Erkut et al state that "holding relaxes the infant by providing tactile stimulation" 1 ; this is insufficient as an analgesic mechanism to support the hypotheses that loosely swaddled infants held in upright or supine positions in the lap of a nurse could have their pain effectively decreased during heel lance procedures. Research suggests that analgesic strategies such as breastfeeding and skin-to-skin care are effective due to multisensory stimulation of tasting, tactile, olfactory, and auditory mechanisms.…”

Section: Disclosurementioning

confidence: 99%