Lago Paola, Garetti Elisabetta, Boccuzzo Giovanna, Merazzi Daniele, Pirelli Anna, Pieragostini Luisa, Piga Simone, Cuttini Marina, Ancora Gina
Neonatal Intensive Care Unit, Department of Woman's and Child's Health, Azienda Ospedaliera-University of Padova, Padova, Italy.
Paediatr Anaesth. 2013 May;23(5):407-14. doi: 10.1111/pan.12107. Epub 2013 Jan 10.
National and international guidelines have been published on pain control and prevention in the newborn, but data on compliance with these guidelines are lacking.
To document current hospital practices for analgesia at neonatal intensive care units (NICUs) 5 years after national guidelines were published in Italy.
A computer-based questionnaire was sent to all registered Italian level II and level III NICUs to investigate their routine pain control practices.
The analgesia and sedation currently used for invasive procedures as compared with best practices.
The questionnaire was returned by 103 of the 118 NICUs (87.3%), most of which (85.4%) knew of the national guidelines on procedural pain control and prevention, and used some analgesic measures during invasive procedures. One or more nonpharmacological interventions were only used routinely by 64.1% of the NICUs for heel pricks and venipuncture, 56.0% for percutaneous insertion of central catheters, 69.7% for nasal CPAP, and 62.4% for eye tests to screen for retinopathy of prematurity. Pain medication was routinely administered at 34.3% NICUs for tracheal intubation, 46.6% for mechanical ventilation (MV), 12.9% for tracheal aspiration, 71.4% for chest tube insertion, 33.0% for lumbar puncture, and 64.0% for postoperative pain. Pain was routinely monitored at only 22.7% of the units during MV, 12.1% for nCPAP, and 21.8% postoperatively.
This survey showed that most Italian NICUs provide some form of analgesia and sedation for invasive procedures in accordance with national guidelines, but their routine adherence to best practices for pain control and monitoring is still suboptimal.
国内外已发布关于新生儿疼痛控制与预防的指南，但缺乏有关这些指南依从性的数据。
记录意大利发布国家指南5年后，新生儿重症监护病房（NICU）当前的镇痛医院实践。
向所有登记在册的意大利二级和三级NICU发送基于计算机的问卷，以调查其常规疼痛控制实践。
与最佳实践相比，目前用于侵入性操作的镇痛和镇静情况。
118个NICU中有103个（87.3%）回复了问卷，其中大多数（85.4%）知晓国家关于操作疼痛控制与预防的指南，并在侵入性操作期间采取了一些镇痛措施。仅64.1%的NICU在足跟采血和静脉穿刺时常规使用一种或多种非药物干预措施，56.0%用于经皮中心静脉导管插入，69.7%用于鼻持续气道正压通气（CPAP），62.4%用于早产儿视网膜病变筛查的眼部检查。34.3%的NICU在气管插管时常规给予止痛药物，46.6%用于机械通气（MV），12.9%用于气管吸引，71.4%用于胸腔置管，33.0%用于腰椎穿刺，64.0%用于术后疼痛。在MV期间，仅22.7%的科室常规监测疼痛，鼻CPAP时为12.1%，术后为21.8%。
本次调查表明，大多数意大利NICU根据国家指南为侵入性操作提供了某种形式的镇痛和镇静，但它们在疼痛控制和监测方面对最佳实践的常规依从性仍不理想。
