Plans to reduce pain in the neonatal intensive care unit NICU

[Dave ARNP]

[Plans to reduce pain in the neonatal intensive care]

[Article in German]

Hubler A.

Klinik fur Kinder- und Jugendmedizin der Friedrich-Schiller-Universitat Jena. [email protected]

Prolonged pain influences behaviour and physiological regulation in preterm infants undergoing intensive care. Insufficient pain treatment results in increased morbidity and mortality. Long-term consequences of stress and pain yet are not clear, but associations with neurobehavioral and developmental sequelae are discussed. A number of psychometric constructs (pain scales) are available to identify pain indicators. These pain scales represent the basis to consider treatment strategies. Main indications are painful interventional procedures, analgesia during mechanical ventilation and the reduction of pain following surgery. Supporting approaches to reduce pain and stress relate to infant's behaviour, care of the professionals and improvement of "infant's world". Pharmacologic interventions are practicable with acetaminophen in mild pain and with opioid drugs (fentanyl and morphine) in moderate and severe pain. A pure or complementary sedative agent can provide physiological stability in settings in which there are less acutely painful stimuli. After standard pain evaluation it is necessary to individualize treatment, to monitor clinical situation and to adjust dosage. Actual knowledge allows an effective reduction of pain even in very premature infants. Because of lack of clarity about early development of pain and stress reactivity at the time it is necessary to estimate benefits against potential risks of therapy.

PMID: 14689328 [PubMed - in process]

http://www.docguide.com/news/content.nsf/PaperFrameSet?OpenForm&refid=2&id=48dde4a73e09a969852568880078c249&c=&newsid=8525697700573E1885256E06003A4799&u=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=14689328&ref=/news/content.nsf/SearchResults?openform&Query=actiq&so=date&id=48dde4a73e09a969852568880078c249

[prmenrs, RN]

Thnks for this article, Dave. I have copied your thread to the NICU forum, I hope you don't mind.

[Dave ARNP]

Not at all!

Pain is pain and pain should be eliminated! Even the wee wittle ones deserve releif!

-Dave

[prmenrs, RN]

Dave has done a great job researching this topic; mosey on over to the pain forum and read on.....

[dawngloves, BSN, RN]

Slight hijack:

What kind of pain scales are your units using?

[prmenrs, RN]

We used the PIPPs--drives ME to a 10. Anyone who knows any nurse researchers out there--we need a new scale.

[Gompers, BSN, RN]

We've used the N-PASS for 2 years now and love it. It's very simple to use and addresses gestational age as well. Another great thing is that there is a sedation assessment with the tool as well, so you know if you're under or over sedating a baby. VERY useful post op and with really sick kids who need to be heavily sedated on the vent but they don't want paralysis.

http://n-pass.com/

The tool is on this site, which is very informative.

:)

[dawngloves, BSN, RN]

Ooo! Gompers that's great! We use CRIES and it is so inapproriate for a 24 weeker!

[Gompers, BSN, RN]

Ooo! Gompers that's great! We use CRIES and it is so inapproriate for a 24 weeker!

You should DEFINITELY get your nurse manager to look into this! The website has a copy of the tool, and the contact information for the developers. It's rather new, but it's been researched as very effective.

For preemies, we just add points according to their corrected gestational age. A 24 weeker already has a pain score of 3 before you even look at him. Yes, this will cause younger preemies to have higher pain scores overall, which will lead to more regular analgesia. That, in a way, is the point - their neuro systems are so raw that they SHOULD be given pain meds until they are more developed and better able to deal with handling and stress.

We do the pain scoring with vital signs, either hands-on or monitored. The sedation assessment you can ONLY do when you are doing hands-on care, because you have to determine how a baby is reacting to stimulation.

[prmenrs, RN]

That looks MUCH better!

[kids]

Another slight hi-jack with my .02

I'll preface this by saying that any tool has flaws and nursing judgement needs to play a big role in determining pain in patients that can't verbalize...

72 hours after having his chest cracked for open heart the CRIES tool indicated my grandson didn't need any pain meds. Looking at the N-Pass I see it would have been a better tool in his case.

[Mimi2RN, ASN, RN]

Anyone using NIPS? We are going to be using that pain scale, when our new paperwork comes out. It will be a new concept for us.