Kaur Hardeep, Negi Vandana, Sharma Mukti, Mahajan Gaurav
Graded Specialist (Paediatrics), Military Hospital Nasirabad, Rajasthan, India.
Head of Department (Paediatrics & Neonatology), Base Hospital Delhi Cantt 10, India.
Med J Armed Forces India. 2019 Apr;75(2):140-145. doi: 10.1016/j.mjafi.2017.12.009. Epub 2018 Feb 4.
Neonates being nonverbal are unable to express their pain leading to underestimation of their pain and hence insufficient pain relief. Neonatal pain is assessed by pain scales based on the behavioural and physiological changes that occur in response to painful stimuli. This cross sectional study was conducted at a tertiary care centre using Premature Infant Pain Profile (PIPP) score with 4% lidocaine as local anaesthetic agent to produce surface anaesthesia of skin prior to intravenous cannulation.
Sample size was collected by simple randomisation method. Our study groups included 50 term and 50 preterm neonates with POG of 28-40 weeks requiring IV cannulation. Heart rate (HR), SpO, facial expressions and behavioural state were noted before venipuncture and after venipuncture using PIPP scale. Same cohort of patients was assessed for pain response after applying 4% lidocaine cream during future venipuncture with help of PIPP score.
The PIPP score in preterm group before and after anesthesia was 11.28 ± 3.72 and 9.58 ± 3.39. PIPP score in term group before and after anesthesia was 11.54 ± 2.84 and 9.04 ± 2.97. There was reduction in mean PIPP score after using topical anesthetic agent in both study groups and the results were statistically significant.
This study found that topical anesthetic agents were effective in reducing pain during venipuncture. Based on the facts of the study, it is recommended that pain scoring should be a part of routine monitoring in neonatal intensive care units and appropriate measures should be used to reduce pain.
新生儿无法用言语表达疼痛，这导致他们的疼痛被低估，从而止痛措施不足。新生儿疼痛通过基于对疼痛刺激做出反应时发生的行为和生理变化的疼痛量表来评估。本横断面研究在一家三级护理中心进行，使用早产婴儿疼痛量表（PIPP）评分，并以4%利多卡因作为局部麻醉剂，在静脉置管前对皮肤进行表面麻醉。
采用简单随机化方法收集样本量。我们的研究组包括50名足月儿和50名早产儿，胎龄为28 - 40周，需要进行静脉置管。在静脉穿刺前和穿刺后使用PIPP量表记录心率（HR）、血氧饱和度（SpO）、面部表情和行为状态。在未来静脉穿刺时，对同一组患者在涂抹4%利多卡因乳膏后，借助PIPP评分评估疼痛反应。
早产组麻醉前后的PIPP评分为11.28±3.72和9.58±3.39。足月儿组麻醉前后的PIPP评分为11.54±2.84和9.04±2.97。两个研究组在使用局部麻醉剂后，平均PIPP评分均降低，结果具有统计学意义。
本研究发现局部麻醉剂在减轻静脉穿刺疼痛方面有效。基于该研究事实，建议疼痛评分应成为新生儿重症监护病房常规监测的一部分，并应采取适当措施减轻疼痛。
