Avaliação e tratamento da dor no recém-nascido

Abstract

Objectives

to update information about available neonatal pain assessment and pain relief methods. Method: medical literature review of the past 10 years, including textbooks, general reviews, systematic reviews, prospective, randomized controlled studies, retrospective works and case studies. Literature was reviewed based on the author clinical and scientific experience regarding pain evaluation and treatment. Results: lack of verbal expression of pain is one of the major impediments to adequate pain relief in the neonatal period. Nowadays, several valid pain assessment tools are available, including the analysis of the neonate facial features and multidimensional tools, as NIPS, CRIES, and PIPP. Non-pharmacological pain relief can be achieved by non-nutritive suction and suction of dextrose water. Neonatal analgesia, in general, includes de the use of paracetamol, opioids and local anesthetics. Opioids remain the main resource for acute pain treatment in the neonatal intensive care unit. Sedatives are important agents to decrease patient activity and restlessness, but they do not relieve pain. Conclusion: based on medical, ethical, and humanitarian grounds, neonatal pain should be considered and treated.

Method

medical literature review of the past 10 years, including textbooks, general reviews, systematic reviews, prospective, randomized controlled studies, retrospective works and case studies. Literature was reviewed based on the author clinical and scientific experience regarding pain evaluation and treatment. Results: lack of verbal expression of pain is one of the major impediments to adequate pain relief in the neonatal period. Nowadays, several valid pain assessment tools are available, including the analysis of the neonate facial features and multidimensional tools, as NIPS, CRIES, and PIPP. Non-pharmacological pain relief can be achieved by non-nutritive suction and suction of dextrose water. Neonatal analgesia, in general, includes de the use of paracetamol, opioids and local anesthetics. Opioids remain the main resource for acute pain treatment in the neonatal intensive care unit. Sedatives are important agents to decrease patient activity and restlessness, but they do not relieve pain. Conclusion: based on medical, ethical, and humanitarian grounds, neonatal pain should be considered and treated.

Results

lack of verbal expression of pain is one of the major impediments to adequate pain relief in the neonatal period. Nowadays, several valid pain assessment tools are available, including the analysis of the neonate facial features and multidimensional tools, as NIPS, CRIES, and PIPP. Non-pharmacological pain relief can be achieved by non-nutritive suction and suction of dextrose water. Neonatal analgesia, in general, includes de the use of paracetamol, opioids and local anesthetics. Opioids remain the main resource for acute pain treatment in the neonatal intensive care unit. Sedatives are important agents to decrease patient activity and restlessness, but they do not relieve pain. Conclusion: based on medical, ethical, and humanitarian grounds, neonatal pain should be considered and treated.

Conclusion

based on medical, ethical, and humanitarian grounds, neonatal pain should be considered and treated.

Resumen

Objetivos

atualizar e divulgar os conhecimentos disponíveis a respeito das técnicas de avaliação e das medidas para o alívio da dor no recém-nascido

Método

revisão da literatura médica dos últimos 10 anos, incluindo livros-texto, revisões, metanálises, trabalhos prospectivos randomizados e controlados, além de estudos retrospectivos e relatos de casos. Esse material foi confrontado com a experiência do serviço e do autor em relação à avaliação e ao tratamento da dor do recém-nascido.

Resultados

a dificuldade de avaliação da dor constitui-se no maior obstáculo ao tratamento adequado da dor no período neonatal. Existem hoje vários instrumentos validados para avaliar a dor do recém-nascido, destacando-se a análise da mímica facial, e as escalas multidimensionais como NIPS, PIPP e CRIES. O tratamento da dor baseia-se em medidas não farmacológicas, como a sucção não nutritiva e água com açúcar, e no uso de analgésicos Dentre os medicamentos destacam-se o paracetamol, os opióides, que são a principal arma no tratamento da dor aguda, e os anestésicos locais. Os sedativos, como os diazepínicos, diminuem a atividade e a agitação do paciente, mas não aliviam a dor.

Conclusão

do ponto de vista médico, ético e humanitário, a dor do recém-nascido deve ser considerada e tratada.