Opioids for procedural pain in neonates

AbstractAcute obstructive uropathy is associated with significant morbidity among patients with any condition that leads to urinary tract obstruction. Immediate urinary diversion is necessary to prevent further damage to the kidneys. In many centres, the two main treatment options include percutaneous nephrostomy (PCN) and retrograde ureteral stenting (RUS). The purpose of this study if to compare the efficacy and safety of PCN and RUS for the treatment of acute obstructive uropathy. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL, EMBASE, the World Health Organisation International Clinical Trials Registry Platform and ClinicalTrials.gov. We also searched the reference lists of included studies to identify any additional trials. We included randomised controlled trials and controlled clinical trials comparing the outcomes of clinical improvement (septic parameters), hospitalisation duration, quality of life, urinary-related symptoms, failure rates, post-procedural pain [measured using a visual analogue scale (VAS)] and analgesics use. We conducted statistical analyses using random effects models and expressed the results as risk ratio (RR) and risk difference (RD) for dichotomous outcomes and mean difference (MD) for continuous outcomes, with 95% confidence intervals (CIs). Seven trials were identified that included 667 patients. Meta-analysis of the data revealed no difference in the two methods in improvement of septic parameters, quality of life, failure rates, post-procedural pain (VAS), or analgesics use. Patients receiving PCN had lower rates of haematuria and dysuria post-operatively and longer hospitalisation duration than those receiving RUS. PCN and RUS are effective for the decompression of an obstructed urinary system, with no significant difference in most outcomes. However, PCN is preferable to RUS because of its reduced impact on the patient’s post-operative quality of life due to haematuria and dysuria, although it is associated with slightly longer hospitalisation duration.

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Methadone effectively attenuates acute and long-term consequences of neonatal repetitive procedural pain in a rat model

Pediatric Research ◽

10.1038/s41390-020-01353-x ◽

2021 ◽

Author(s):

Nynke J. van den Hoogen ◽

Thomas J. de Geus ◽

Jacob Patijn ◽

Dick Tibboel ◽

Elbert A. Joosten

Keyword(s):

Rat Model ◽

Procedural Pain ◽

Long Term Consequences

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Massage therapy as a non-pharmacological analgesia for procedural pain in neonates: A scoping review

Complementary Therapies in Medicine ◽

10.1016/j.ctim.2021.102735 ◽

2021 ◽

pp. 102735

Author(s):

Siti Yuyun Rahayu Fitri ◽

Khadidjah Siti ◽

Nurhidayah Ikeu ◽

Nenden Nur Asriyani Maryam

Keyword(s):

Scoping Review ◽

Massage Therapy ◽

Procedural Pain

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Hypnotherapy for Procedural Pain and Distress in Children: A scoping Review Protocol

Pain Medicine ◽

10.1093/pm/pnab038 ◽

2021 ◽

Author(s):

Daly Geagea ◽

Zephanie Tyack ◽

Roy Kimble ◽

Lars Eriksson ◽

Vince Polito ◽

...

Keyword(s):

Scoping Review ◽

Grey Literature ◽

Cochrane Library ◽

Procedural Pain ◽

Future Research ◽

Theoretical Frameworks ◽

Eligibility Criteria ◽

Pharmacological Agents ◽

Review Protocol ◽

Meta Analyses

Abstract Objective Inadequately treated pain and distress elicited by medical procedures can put children at higher risks of acute and chronic biopsychosocial sequelae. Children can benefit from hypnotherapy, a psychological tailored intervention, as an adjunct to pharmacological agents to address the multiple components of pain and distress. Despite providing evidence on the effectiveness and potential superiority of hypnotherapy to other psychological interventions, research on hypnotherapy for paediatric procedural pain and distress has been predominantly limited to oncology and needle procedures. Plus, there is a lack of reporting of intervention manuals, factors influencing hypnotic responding, pain unpleasantness outcomes, theoretical frameworks, adverse events, as well as barriers and facilitators to the feasibility of delivering the intervention and study procedures. The proposed review aims to map the range and nature of the evidence on hypnotherapy for procedural pain and distress in children to identify gaps in literature and areas requiring further investigation. Methods This review will follow the Arksey and O'Malley (2005) methodology and incorporate additional scoping review recommendations by The Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses. Relevant studies will be identified through searching published literature databases (PubMed, Cochrane Library, PsycINFO, Embase, CINAHL, Scopus and Web of Science) and grey literature in addition to hand-searching of reference lists and key journals. Two authors will independently screen titles and abstracts of search results followed by full-texts review against eligibility criteria. Conclusion Findings are anticipated to guide future research and inform the development of tailored hypnotic interventions in children.

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Understanding Patient Anxiety and Pain During Initial Image-guided Breast Biopsy

Journal of Breast Imaging ◽

10.1093/jbi/wbaa072 ◽

2020 ◽

Vol 2 (6) ◽

pp. 583-589

Author(s):

Santo Maimone ◽

Andrey P Morozov ◽

Annamaria Wilhelm ◽

Inna Robrahn ◽

Tedra D Whitcomb ◽

...

Keyword(s):

Breast Biopsy ◽

Procedural Pain ◽

Patient Anxiety ◽

Initial Image ◽

Image Guided ◽

Pain Scores ◽

Multiple Biopsies ◽

Lower Pain ◽

Malignant Lesions ◽

Positive Correlations

Abstract Objective Image-guided breast biopsies are safe, efficient, and reliable. However, patients are often anxious about these procedures, particularly those who have never undergone a prior biopsy. Methods This prospective IRB-approved study surveyed 163 patients undergoing their first breast biopsy. Participants provided informed consent and completed a short written survey prior to and immediately after their procedure. Level of anxiety as well as anticipated and actual levels of pain prior to and following the procedure were assessed using a 0–10-point Likert scale. Correlation, bivariate, and regression analyses were performed. Results Regarding the biopsy experience, 133/163 (81.6%) of patients reported it as better than expected. Anxiety decreased significantly from a prebiopsy mean score of 5.52 to a postbiopsy mean score of 2.25 (P < 0.001). Average and greatest pain experienced during the procedure had mean scores of 2.03 and 2.77, respectively, both significantly lower compared to preprocedural expectation (mean 4.53) (P < 0.001). Lower pain scores were reported in US-guided procedures compared to stereotactic- and MRI-guided biopsies (P < 0.001). No significant differences in pain scores were seen in those undergoing single versus multiple biopsies, or when benign, elevated-risk, or malignant lesions were sampled. Positive correlations were seen with prebiopsy anxiety levels and procedural pain as well as with anticipated pain and actual procedural pain. Conclusion Image-guided biopsies are often better tolerated by patients than anticipated. We stress the benefit of conveying this information to patients prior to biopsy, as decreased anxiety correlates with lower levels of pain experienced during the procedure.

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