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ID naloge: 133 Letnik: 2002 Predmet: pediatrija
Prepoznava, obravnava in preprecevanje bolecine pri novorojenckih in dojenckih
Avtor: Veronika Rutar, Tanja Javh
Mentor: prof. dr. David Neubauer
IZHODIŠCE. Prepoznava in vrednotenje bolecine pri novorojenckih in dojenckih je težavno. Obravnava in preprecevanje bolecine pri tej starostni skupini ni optimalno. Nefarmakološki in farmakološki ukrepi za preprecevanje bolecine pri manjših invazivnih posegih se redko uporabljajo. Dosedanje raziskave kažejo na ucinkovitost raztopin sladkorjev in lokalnih anestetikov pri zmanjšanju odziva na bolecino ob posegih.
NAMEN. V klinicni praksi bi uvedba uporabnega in enostavnega merila za ocenjevanje bolecine omogocila objektivnejšo oceno stopnje bolecine in olajšala nacrtovanje ukrepov za preprecevanje bolecine ter oceno ucinkovitosti teh ukrepov. Naš namen je bil oceniti uporabnost in veljavnost lestvice za ocenjevanje bolecine pri novorojenckih in dojenckih - Neonatal Infat Pain Scale (NIPS). Želeli smo oceniti tudi možnosti preprecevanja bolecine ob manjših invazivnih posegih pri novorojenckih in dojenckih in objektivno oceniti tovrstne ukrepe preprecevanja.
HIPOTEZE. 1. Lestvica NIPS je uporabna pri ocenjevanju bolecine pri novorojenckih in dojenckih. 2. Uporaba oralno aplicirane raztopine glukoze pri novorojenckih in dojenckih zmanjša odziv na bolecino ob venepunkciji ali nastavitvi intravenske poti. 3. Uporaba lokalnega anestetika na mestu posega pri novorojenckih in dojenckih zmanjša odziv na bolecino ob venepunkciji ali nastavitvi intravenske poti.
METODE. V raziskavo smo vkljucili 60 nakljucno izbranih novorojenckov in dojenckov, ki so potrebovali venepunkcijo oz. nastavitev intravenske poti. Ocenjevali smo odziv na bolecino in ucinkovitost ukrepov za preprecevanje bolecine. Glede na ukrepe preprecevanja bolecine smo jih razdelili na tri skupine: (1) brez ukrepov, (2) glukozna raztopina, (3) lokalni anestetik. Uporabnost lestvice smo preverjali s Cronbachovim koeficientom á (á) in s Pearsonovim korelacijskim koeficientom (r). Testiranje razlik med skupinami smo analizirali s statisticnim testom za enosmerno analizo variance za neodvisne vzorce.
REZULTATI. Vrednosti á za notranjo skladnost so bile med 0,87 in 0,91; vrednosti r za objektivnost so bile med 0,86 in 0,94; vrednosti r za socasno veljavnost so bile med 0,38 in 0,48. Razlike med skupinami z razlicnimi ukrepi so vidne, vendar ne statisticno znacilne.
ZAKLJUCKI. Z omenjenimi rezultati smo potrdili hipotezo, da je lestvica NIPS uporabna. Rezultati pri uporabnosti ukrepov za zmanjšanje odziva na bolecino pri novorojenckih in dojenckih nakazujejo ugoden vpliv glukoze, vendar ne dokazujejo 2. hipoteze, in kažejo na neucinkovitost lokalnega anestetika, s cimer smo zavrnili 3. hipotezo.
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[Abstract / English version]
Prepoznava, obravnava in preprecevanje bolecine pri novorojenckih in dojenckih
Author: Veronika Rutar, Tanja Javh
Mentor: prof. dr. David Neubauer
BACKGROUND. Pain assessment and evaluation in neonates and infants remains a significant problem. Pain management and prevention in this age group is less than optimal. Nonpharmacologic and pharmacologic interventions for relief of pain during minor invasive procedures are infrequently employed. Recent research evidence has shown the efficacy of sugar solutions and topical anaesthetics for relief of procedural pain.
AIMS. The employement of neonatal pain assessment tools that are easily aplicable in clinical settings would provide more objective evaluation of pain response, the development of pain management care plans, and the effectiveness of pain relief interventions. The objectives of this study were to assess the applicability of NIPS in clinical settings and evaluate effective and safe interventions that relieve pain in neonates and infants.
HYPOTHESES. 1. NIPS is applicable in the clinical settings. 2. Oral glucose solution is effective in reducing pain-related behavior in neonates and infants undergoing minor invasive procedures. 3. Application of topical anaesthetic is effective in reducing pain-related behavior in neonates and infants undergoing minor invasive procedure.
METHODS. 60 neonates and infants undergoing venepuncture and intravenous catheter insertion randomly assigned to one of three treatment groups: (1) no treatment, (2) oral glucose solution, (3) topical anaesthetic. Statistical analysis: internal consistency of NIPS was established by Cronbach's alphas; interrater reliability of NIPS was established by Pearson's correlations, concurrent validity was established by correlations with heart rate. Differences between group median pain scores were established by analyses of variance.
RESULTS. Internal consistency was high: Cronbach's alphas ranged from 0,87 to 0,91. Interrater reliability was high: Pearson's correlations ranged from 0,86 to 0,94. Concurrent validity with heart rate was medium-high: Pearson's correlations were from 0,38 to 0,48. Differences between group median pain scores were apparent, but did not reach statistical significance.
CONCLUSIONS. Results of the study confirmed our first hypothesis. The study of differences between results of different groups indicate the beneficial effect of glucose, but do not confirm our second hypothesis, and reveal the inefficiency of topical anaesthetic and thus disprove our third hypothesis.
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