Bellieni C V, Aloisi A M, Ceccarelli D, Valenti M, Arrighi D, Muraca M C, Temperini L, Pallari B, Lanini A, Buonocore G
Department of Physiology, University of Siena, Le Scotte University Hospital, Viale M Bracci, Siena, Italy.
J Matern Fetal Neonatal Med. 2013 Mar;26(4):419-22. doi: 10.3109/14767058.2012.733777. Epub 2012 Nov 7.
To compare the analgesic effect of three treatments to relieve the pain produced by intramuscular injections (IMI) in term newborns, and to assess sex-linked differences in their response to pain.
We studied 62 babies. Each baby received antibiotic IMIs for clinical aims. During each IMI, one of the following analgesic treatments was utilized: oral 33% glucose (OG), sensorial saturation (SS), or topic anesthetic cream (TAC). SS is a validated analgesic method, based on the combination of three stimulations (tactile, acoustic and gustative). During the IMI, pain level was assessed with the use of the DAN scale, a validated neonatal pain scale. All babies who received three distinct analgesic procedures for three distinct IMIs were enrolled. Mean pain scores of the three analgesic treatment groups were compared. We then compared mean pain scores of females vs males in the whole cohort and within each treatment group.
The 95% Confidence Intervals of pain scores were 5.6-6.5 for TAC, 1.4-2.3 for OG and 0.6-1.2 for SS: when treated with TAC, babies' pain scores were significantly higher than with OG or SS (p <0.0001); when treated with OG, babies' pain scores were higher than SS (p = 0.002). Females' mean pain score was significantly higher than males' mean pain score: (95% CI: 2.9-4.1 vs 2.0-3.1; p = 0.01). OG and SS produced significantly higher mean DAN scores in females than in males. Also in the TAC group females' mean DAN scores were higher than males, though this last difference was not statistically significant.
This is the first study to show the effectiveness of nonpharmacologic analgesia in relieving IMI pain. It is also the first study to clearly show that the sex differences in pain perception are present since birth.
比较三种治疗方法缓解足月儿肌肉注射（IMI）所致疼痛的镇痛效果，并评估其对疼痛反应的性别差异。
我们研究了62名婴儿。每个婴儿因临床目的接受抗生素肌肉注射。在每次肌肉注射期间，采用以下镇痛治疗方法之一：口服33%葡萄糖（OG）、感觉饱和（SS）或局部麻醉膏（TAC）。SS是一种经过验证的镇痛方法，基于三种刺激（触觉、听觉和味觉）的组合。在肌肉注射期间，使用DAN量表（一种经过验证的新生儿疼痛量表）评估疼痛程度。所有接受三次不同肌肉注射的三种不同镇痛程序的婴儿均被纳入研究。比较了三个镇痛治疗组的平均疼痛评分。然后我们比较了整个队列以及每个治疗组中女性与男性的平均疼痛评分。
TAC组疼痛评分的95%置信区间为5.6 - 6.5，OG组为1.4 - 2.3，SS组为0.6 - 1.2：接受TAC治疗时，婴儿的疼痛评分显著高于接受OG或SS治疗时（p <0.0001）；接受OG治疗时，婴儿的疼痛评分高于SS组（p = 0.002）。女性的平均疼痛评分显著高于男性：（95%置信区间：2.9 - 4.1对2.0 - 3.1；p = 0.01）。OG和SS在女性中产生的平均DAN评分显著高于男性。在TAC组中，女性的平均DAN评分也高于男性，尽管最后这一差异无统计学意义。
这是第一项显示非药物镇痛缓解肌肉注射疼痛有效性的研究。这也是第一项清楚表明疼痛感知的性别差异自出生就存在的研究。
