title: Pain management during invasive procedures at Italian NICUs: has anything changed in the last five years?
abstract: OBJECTIVE
  To ascertain the extent to which neonatal analgesia for invasive procedures has changed in the last 5 years since the publication of Italian guidelines.
  
  
  METHODS
  We compared survey data for the years 2004 and 2010 on analgesia policy and practices for common invasive procedures at Italian Neonatal Intensive Care Units (NICUs); 75 NICUs answered questionnaires for both years and formed the object of this analysis.
  
  
  RESULTS
  By 2010 analgesia practices for procedural pain had improved significantly for almost all invasive procedures (p < 0.05), both non-pharmacological and pharmacological methods being adopted by the majority of NICUs (unlike the situation in 2004). The routine use of medication for major invasive procedures was still limited, however (35% of lumbar punctures, 40% of tracheal intubations, 46% during mechanical ventilation). Postoperative pain treatment was still inadequate, and 41% of facilities caring for patients after surgery did not treat pain routinely. Pain monitoring had definitely improved since 2004 (p < 0.05), but not enough: only 21% and 17% of NICUs routinely assess pain during mechanical ventilation and after surgery, respectively.
  
  
  CONCLUSIONS
  There have been improvements in neonatal analgesia practices in Italy since national guidelines were published, but pain is still undertreated and underscored, especially during major invasive procedures. It is mandatory to address the gap between the recommendations in the guidelines and clinical practice must be addressed through with effective quality improvement initiatives.
authors.affiliation: Neonatal Intensive Care Unit, Department of Woman's and Child's Health, Azienda Ospedaliera-University of Padova, Padova, Italy. lago@pediatria.unipd.it
authors.forename: P
authors.initials: P
authors.lastname: Lago
authors.forename: G
authors.initials: G
authors.lastname: Boccuzzo
authors.forename: E
authors.initials: E
authors.lastname: Garetti
authors.forename: A
authors.initials: A
authors.lastname: Pirelli
authors.forename: L
authors.initials: L
authors.lastname: Pieragostini
authors.forename: D
authors.initials: D
authors.lastname: Merazzi
authors.forename: G
authors.initials: G
authors.lastname: Ancora
mesh_terms: D000698:Analgesia / Q000379:methods / Q000592:standards; D003625:Data Collection / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000601:surgery / Q000628:therapy*; D007363:Intensive Care Units, Neonatal; D007558:Italy / Q000453:epidemiology; D059408:Pain Management / Q000592:standards*; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000628:therapy*; D017410:Practice Guidelines as Topic; D058996:Quality Improvement; D011795:Surveys and Questionnaires; D013997:Time Factors