Yenidoğanda farmakoloji dışı ağrı kontrolü

Yenidoğanın ağrıyı çok iyi algıladığı, hatırladığı ve intrauterin yaşamdan itibaren ağrıyı hissedebildiği kanıtlanmıştır. Yenidoğanlarda ağrı fizyolojisinin, klinikle olan ilişkisinin ve sonuçlarının daha iyi anlaşılmasını sağlayan önemli gelişmeler sayesinde, yenidoğan yoğun bakım ünitelerinde ağrı tedavisine daha çok özen gösterilmektedir. Ağrı tedavisinde, farmakolojik ve farmakolojik olmayan yöntemler uygulanmaktadır. Bu derleme, yenidoğanda ağrı yönetiminde kullanılan farmakoloji dışı yöntemleri açıklamaktadır.

Non-pharmacological pain control

It has been proved that newborn could percept and remember pain very well, and could feel pain by the time the intrauterin life started. Significant progress in understanding the physiology, clinical correlates, and consequences of neonatal pain have resulted in greater attention to pain management during neonatal intensive care. Pharmacological and nonpharmacological methods are used in pain management. This review article explains nonpharmacologic therapies for the management of pain in the neonate.

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1. IASP Pain Terminology. Part 3: Pain Terms, A Current List with Definitions and Notes on usage pp 209-214. Classification of Chronic Pain, Second Edition, IASP Task Force on Taxonomy, H.Merskey, N.Bogduk, IASP Press, Seattle, 1994.
2. Smith RP, Gitau R, Glover V, et al. Pain and stress in the human fetus. Eur J Obstet Gynecol Reprod Biol 2000; 92: 161-165.
3. Franck LS, Greenberg CS, Stevens B. Pain assessment in infants and children. Pediatr Clin North Am 2000; 47: 487-512.
4. Anand KJ, Carr DB. The neuroanatomy, neurophysiology, and neurochemistry of pain, stres, and analgesia in newborns and children. Pediatr Clin North Am. 1989; 36: 795-822.
5. Bucher HU, Bucher-Schmid A. Treating pain in the neonate. In:Hansen TN., MacIntosh N.eds. Current topics of neonatology number 1. London: WB. Saunders Company,1996: 85-110.
6. Charles RN, Robert JD. The brain stem: medulla, pons and midbrain. In: Richard WM, John JF(eds). The Human Nervous System. Basic Principles of Neurobiology. McGraw Hill Inc 1981; 268-322.
7. Rahmi Örs. Yenidoğanda Ağrı ve Analjezi. Neonatolojinin Temel ‹lkeleri ve Acilleri. Güneş Tıp Kitabevi 2007; 551-562.
8. Melzack R, Wall PD. Pain mechanisms: a new theory. Science 1965; 150: 971-979.
9. Suresh S, Anand KJS: opioid tolerance in neonates: mechanisms, diagnosis, assessment and management. Semin Perinatol 1998; 22: 425-433.
10. Hatch DJ. Analgesia in the neonate. Br Med J 1987; 294: 920.
11. Chapman CR, Casey KL, Dubner R, Foley KM, Gracely RH, Reading AE. Pain measurement: an overview. Pain 1985; 22: 1-31.
12. Prevention and management of pain and stress in the neonate. American Academy of Pediatrics. Committee on Fetus and Newborn. Committee on Drugs. Section on Anesthesiology. Section on Surgery. Canadian Paediatric Society. Fetus and Newborn Committee. Pediatrics 2000; 105: 454-61.
13. Carbajal R, Rousset A, Danan C, Coquery S, Nolent P, Ducrocq S, et al. Epidemiology and treatment of painful procedures in neonates in Intensive Care Units. JAMA 2008; 300: 60-70.
14. Chiswick M.L. Assessment of pain in neonates. The Lancet 2000; 355: 6-8.
15. Mathew PJ, Mathew JL. Assessment and management of pain in infants. Postgraduate Medical Journal, Health & Medical Complete 2003;79: 438-443.
16. Stevens B, Gibbins S, Sturla Franck L. Acute pain in children. Treatment of pain in the neonatal intensive care unit. Pediatr Clin North Am 2000;47: 633-650.
17. Guidelines for procedural pain in the newborn. Paola Lago, Elisabetta Garetti, Daniele Merazzi, Luisa Pieragostini,Gina Ancora, Anna Pireli,Carlo Valerio Bellieni on behalf of the Pain Study Group of the Italian Society of Neonatology. Acta Paediatrica 2009;98: 932-939.
18. Brady-Fryer B, Wiebe N, Lander JA. Pain relief for neonatal circumcision. The Cochrane Library. Cochrane Database Syst Rev 2004. 18(4).
19. Krechel SW, Bildner J. CRIES: a new neonatal postoperative pain measurement score, initial testing of validity and reliability. Paediatr Anaesth 1995; 5: 53-61.
20. Stevens BJ., Granau RVE. Issues of assessment of pain and discomfort in neonates, JOGNN 1995; 24: 849-855.
21. Lawrence J, Alcock D, McGrath P, Kay J, MacMurray S.B, Dulberg C. The development of a tool to assess neonatal pain, Neonatal Network,12(6): 59-64.
22. Akdovan T. Sağlıklı yenidoğanlarda ağrının değerlendirilmesi, emzik verme ve kucağa alma yönteminin etkisinin incelenmesi. Yüksek lisans tezi, İstanbul, Marmara Üniversitesi, 1999.
23. Grunau RV, Whitfield MF, Petrie JH. Pain sensitivity and temperament in extremely low-birth-weight premature todlers and preterm and full term controls. Pain 1994;58: 341-346.
24. Stevens B, Johnston C, Patrica P, Anna T. Premature infant pain profile: Development and initial validation. Clinical Journal of Pain 1996; 12: 13-22.
25. Cignacco E, Hamers JPH, Stoffel L, et al. The efficiacy of nonpharmacological interventions in the management of procedural pain in preterm and term neonates. A systematic literature review. Eur J Pain 2007; 11: 139-152.
26. Chang YJ, Anderson G.C., Lin C.H. Effects of prone and supine positions on sleep state and stress responses in mechanically ventilated preterm infants during the first postnatal week. Issues and innovations in nursing practice. Journal of Advanced Nursıng 2002; 40: 161-169.
27. Stevens B, Johnston CC. Physiologic response of premature infants to a painful stimulus. Nurs Res 1994;43: 261-331.
28. Anderson GC. The mother and her newborn: mutual caregivers. J Obstet Gynecol Neonatal Nurs 1997; 6: 50-57.
29. Gray L, Watt L, Blass EM. Skin to skin contact is analgesic in healthy newborns. Pediatrics 2000; 105: 14.
30. Johnston CC, Stevens B, Pinelli J, Gibbins S, Filion F, Jack A, Steele S, Boyer K, Veilleux A. Kangaroo care is effective in diminishing pain response in preterm neonates. Arch Pediatr Adolesc Med 2003;157: 1084-1088.
31. Tessier R, Cristo M, Velez S, Giron M, Ruiz-Palaez JG, Charpak Y, Charpak N. Kangaroo mother care and the bonding hypothesis. Pediatrics 1998; 102: 17-27.
32. Diego MA, Field T, Hernandez-Reif M. Vagal activity, gastric motility and weight gain in massaged preterm neonates. J Pediatr 2005;147: 50-55.
33. Jones JE, Kassity N. Varieties of alternative experience: complementary care in the neonatal intensive care unit. Clin Obstet Gynecol 2001; 44: 750-768.
34. Wheeden A, Scafidi FA, Field T, et al. Massage effects on cocaineexposed preterm neonates. Dev Behav Pediatr 1993;14: 318-322.
35. Field T, Goldson E. Pacifying effects of nonnutritive sucking on term and preterm neonates during heelstick procedures. Pediatrics 1984;74: 1012-15.
36. Corbo MG, Mansi G, Stagni A, Romano A, Van den Heuvel J, Capasso L, et al. Nonnutritive sucking during heelstick procedures decreases behavioral distress in the newborn infant. Biol Neonate 2000; 77: 162-167.
37. Eva Cignacco, Jan P.H. Hamers, Lilian Stoffel, Richard A. van Lingen, Peter Gessler, Jane McDougall, Mathias Nelle. The efficacy of non-pharmacological interventions in the management of procedural pain in preterm and term neonates. A systematic literature review. Eur J Pain. 2007;11: 139-152.
38. Shiao SY, Chang YJ, Lannon H, Yarandia H. Meta analysis of the effects of nonnutritive sucking on heart rate and peripheral oxygenation: research from the past 30 years. Issues Compr Pediatr Nurs 1997; 20: 11-24.
39. Stevens B, Johnston C, Franck L, Petryshen P, Jack A, Foster G. The efficacy of developmentally sensitive interventions and sucrose for relieving procedural pain in very low birth weight neonates. Nurs Res 1999; 48: 35-43.
40. Bellieni CV, Buonocore G, Nenci A, Franci N, Cordelli DM, Bagnoli F. Sensorial saturation: an effective analgesic tool for heelprick in preterm infants. Biol Neonate 2001; 80: 15-18.
41. Gibbins S, Stevens B. Mechanisms of sucrose and non-nutritive sucking in procedural pain management in infants. Pain Res Manag 2001; 6: 21-28.
42. Blass E, Fitzgerald E, Kehoe P. Interactions between sucrose, pain and isolation distress. Pharmacol Biochem Behav 1987; 26: 483-489.
43. Gradin M, Schollin J. The role of endogenous opioids in mediating pain reduction by orally administered glucose among newborns. Pediatrics 2005; 115: 1004-1007.
44. Blass EM, Shah A. Pain-reducing properties of sucrose in human newborns. Chem Senses 1995; 20: 29-35.
45. Stevens B, Yamada J, Ohlsson A. Sucrose for analgesia in newborn infants undergo›ng painful procedures. Cochrane Database Syst Rev 2004; 3 CD001069
46. Gibbins S, Stevens B, Hodnett E, Pinelli J, Ohlsson A, Darlington G. Efficacy and safety of sucrose for procedural pain relief in preterm and term neonates. Nurs Res 2002; 51: 375-82.
47. Johnston CC, Straimer R, Horton L, Friedman A. Effect of repeated doses of sucrose during heel stick procedure in preterm neonates. Biol Neonate 1999; 75: 160-166.
48. Stevens B, Taddio A, Ohlsson A, Einarson T. The efficacy of sucrose for relieving procedural pain in neonates- a systematic review and meta analysis. Acta Paediatr 1997; 86: 837-842.
49. Johnston CC, Filion F, Snider L, Majnemer A, Limperopoulos C, Walker CD,et al. Routine sucrose analgesia during the first week of life in neonates younger than 31 weeks postconceptional age. Pediatrics 2002; 110: 523-528.
50. Willis D, Chabot J, Radde I, Chance G. Unsuspected hyperosmolality of oral solutions contributing to necrotising enterocolitis in vey-low-birth-weight infants. Pediatrics 1977; 60: 535-538.
51. Gradin M, Eriksson M, Holmqvist G, Holstein A, Schollin J. Pain reduction at venipuncture in newborns: oral glucose compared with local anaesthetic cream. Pediatrics 2002; 110: 1053-1057.
52. Carbajal R, Veerapen S, Couderc S, Jugie M, Ville Y. Analgesic effect of breast feding in term neonates: randomised controlled trial. BMJ, 2003; 326: 13-15.
53. Gray L, Miller LW, Philipp BL, Blass EM. Breastfeeding is analgesic in healthy newborns. Pediatrics 2002; 109: 590-593.
54. Bo LK, Callaghan P. Soothing pain-eicited distress in Chinese neonates. Pediatrics 2000; 105:e49.
55. Butt M, Kisilevsky S. Music modulates behaviour of premature infants following heel lance. Can J Nurs Res 2000; 31: 17-39.
56. Sharek PJ, Powers R, Koehn A, et al: Evaluation and development of potentially better practices to improve pain management of neonates. Pediatrics 2006; 118: S78-S86.
57. Dunbar AE, Sharek PJ, Mickas NA, et al: Implementation and case- study results of potentially better practices to improve pain management of neonates. Pediatrics 2006; 118: S87-S94.