title: Pain relief in ventilated preterms during endotracheal suctioning: a randomized controlled trial.
abstract: BACKGROUND
  In Switzerland approximately 8% of infants are born prematurely. Some of them undergo mechanical ventilation including endotracheal suctioning (ETS). ETS is one of the most frequently performed interventions and is linked to stress and pain, but its treatment is controversial. In Switzerland there is a lack of standardisation in pain relief for ETS.
  
  
  OBJECTIVE
  To test the hypothesis that an intermittent dose of morphine reduces pain during ETS and that subsequent multisensorial stimulation (MSS), as a non pharmacological comforting intervention, helps infants to recover from experienced pain.
  
  
  METHODS
  A randomized placebo controlled trial in two tertiary neonatal intensive care units (NICU) with a sample of 30 mechanically ventilated preterm infants was conducted. Pain was measured by three pain assessment tools (Bernese Pain Scale for Neonates, Premature Infant Pain Profile and Visual Analogue Scale)
  
  
  RESULTS
  Morphine did not lead to any pain relief from ETS as measured by three pain scales. Nor did the comforting intervention of MSS show any effect. Repeated-measure analysis of variance for the within and between groups comparison showed no statistical significance.
  
  
  CONCLUSIONS
  The administration of morphine for pain relief in ventilated preterm neonates during ETS remains questionable and the use of MSS as a comforting intervention after painful stimulus cannot be recommended. The validity testing of the instruments for this patient population should undergo a systematic validation trajectory. Future research should focus on options among non pharmacological interventions for relieving pain during ETS.
authors.affiliation: Institute of Nursing Science, University of Basel, Basel, Switzerland. eva.cignacco@unibas.ch
authors.forename: Eva
authors.initials: E
authors.lastname: Cignacco
authors.forename: Jan P
authors.initials: JP
authors.lastname: Hamers
authors.forename: Richard A
authors.initials: RA
authors.lastname: van Lingen
authors.forename: Lue J I
authors.initials: LJ
authors.lastname: Zimmermann
authors.forename: Romano
authors.initials: R
authors.lastname: Müller
authors.forename: Peter
authors.initials: P
authors.lastname: Gessler
authors.forename: Mathias
authors.initials: M
authors.lastname: Nelle
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000704:Analysis of Variance; D001034:Apgar Score; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D012121:Respiration, Artificial / Q000379:methods*; D013396:Suction / Q000009:adverse effects*
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine