Positioning Effects for Procedural Pain Relief in NICU: Systematic Review

Anilsa Suraya Pedro Gaspar Francisco; Dayane Montemezzo; Simone Nascimento Dos Santos Ribeiro; Bruna Frata; Natália Alves Menegol; Rodrigo Okubo; Anelise Sonza; Luciana Sayuri Sanada

doi:10.1016/j.pmn.2020.07.006

Positioning Effects for Procedural Pain Relief in NICU: Systematic Review

Pain Manag Nurs. 2021 Apr;22(2):121-132. doi: 10.1016/j.pmn.2020.07.006. Epub 2020 Aug 27.

Authors

Anilsa Suraya Pedro Gaspar Francisco¹, Dayane Montemezzo¹, Simone Nascimento Dos Santos Ribeiro², Bruna Frata¹, Natália Alves Menegol¹, Rodrigo Okubo¹, Anelise Sonza¹, Luciana Sayuri Sanada³

Affiliations

¹ Department of Physical Therapy at Santa Catarina State University, Brazil.
² Department of Physical Therapy, Hospital Sofia Feldman, Belo Horizonte, Brazil.
³ Department of Physical Therapy at Santa Catarina State University, Brazil. Electronic address: lu_sanada@yahoo.com.br.

PMID: 32863161
DOI: 10.1016/j.pmn.2020.07.006

Abstract

Objectives: To systematically review the literature regarding the effectiveness of different positioning methods for procedural pain relief in neonates admitted to the Neonatal Intensive Care Unit (NICU).

Design: A systemized search of the literature was carried out by means of two independent evaluators through the systematic search of electronic index databases.

Data sources: A search for relevant studies was performed in four databases (Medline, Web of Science, Scopus, and BVS-BIREME).

Review/analysis methods: Manual searches were conducted on suitable references from the included articles, and 1,941 publications were eligible for the analysis. The flowchart for the articles' selection was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, and in relation to bias risks according to the Physiotherapy Evidence Database (PEDro) scale.

Results: Based on the inclusion criteria, only 20 publications remained. According to the PEDro scale, 75% of the studies presented good methodological quality, with scores between 6 and 8, and 5% scored ≤4 points. None of them were blinded in relation to the therapies, but all of them performed intergroup statistical comparisons. According to the results of this review, we recommend facilitated tucking by parents (FTP) in NICU of at least 30 minutes duration, starting 15 minutes before, during the painful procedure, and 15 minutes after to relieve pain and to stabilize the physiological, hormonal, and behavioral responses of the newborns.

Conclusions: Positioning should be used as a nonpharmacological strategy for procedural pain relief in newborns. This review showed that facilitated tucking by parents for 30 minutes was the best position for pain relief in premature newborns during procedures in the NICU. Positioning is recommended as a nonpharmacological method for pain relief; FTP of at least 30 minutes duration should be the first positioning choice during procedures in the NICU.

Publication types

Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Humans
Infant, Newborn
Intensive Care Units, Neonatal*
Pain / prevention & control
Pain Management
Pain, Procedural* / prevention & control