Enteral Docosahexaenoic Acid Reduces Analgesic Administration in Neonates Undergoing Cardiovascular Surgery.

BACKGROUND: Neonates undergoing surgery require analgesic medication to ameliorate acute pain. These medications produce negative side effects. Docosahexaenoic acid (DHA) has an antinociceptive effect in animals, but this has not been evaluated in human neonates. We evaluated the DHA effect on cumulative dose and duration of analgesics administered to neonates undergoing cardiovascular surgery. METHODS: A secondary analysis was performed with data from a clinical trial, in which enteral DHA was administered perioperatively compared with sunflower oil (SO). Present study assessed the antinociceptive effect of DHA by measuring the cumulative dose and duration of analgesics administered during postoperative stay in a neonatal intensive care unit. Multivariate linear regression models were performed. RESULTS: Seventeen neonates received DHA and 18 received SO in the control group. Compared with the control group, the DHA group received lower cumulative dose (14.6 ± 2.2 vs. 25.2 ± 4.8 µg/kg, p = 0.029) and shorter duration of buprenorphine (2 days (1-8) vs. 4.5 days (1-12); p = 0.053). After adjusting for confounders, the DHA group received significantly lesser buprenorphine (ß = -27 µg/kg, p = 0.028; R2 model = 0.90) for shorter duration (ß = -9 days, p = 0.003; R2 model = 0.94). No differences in fentanyl or ketorolac were detected. CONCLUSIONS: Buprenorphine administration was reduced in neonates who received DHA, suggesting that DHA likely has analgesic effects.

Breastfeeding for acute pain control on infants: a randomized controlled trial / Lactancia materna para control del dolor agudo en lactantes: ensayo clínico controlado, ciego simple

Objective: To determine the effectiveness of breastfeeding (BF) for the management in acute pain after vaccination in infants under 6 months of age when compared to the milk substitute (MS) and not to apply any maneuver. Methods: A controlled, single-blind phase III clinical trial was conducted on infants under 6 months old to evaluate the effectiveness of BF in acute pain by vaccination. Divided in 3 groups: BF, milk substitutes (MS), and without applying any analgesic maneuver (control). Pain was measured by crying time and pediatric pain scale. Statistical analysis was performed using the Kruskal Wallis and Mann-Whitney U for quantitative variables. For qualitative data, Chi2 was applied Kaplan Meier was used to analyze the total time crying. Results: A total of 144 patients were recruited, divided in groups of 48 patients. The group of BF had fewer crying time (p = 0.007) and pain rating at 90 (p = 0.006) and 120 (p = 0.003) seconds compared with other groups. There was no significant difference in the crying time (p = 0.396) and the pain scale between the group receiving MR and control. Conclusions: Breastfeeding is effective in management of acute pain by vaccination in infants under six months of age compared to milk substitute and control.

Objetivo: determinar la eficacia de la lactancia materna (LM) para el manejo del dolor agudo después de la vacunación en lactantes menores de 6 meses al compararse con el sucedáneo de la leche (SL) y no aplicar ninguna maniobra. Métodos: se realizó un ensayo clínico controlado aleatorizado, ciego simple en fase III en lactantes menores de 6 meses de edad. Se incluyeron 3 grupos: LM, SL y sin aplicar analgesia (control). El dolor se midió a través del tiempo de llanto y una escala de dolor pediátrico. En el análisis estadístico se utilizaron las pruebas de Kruskal Wallis y U de Mann Whitney para variables cuantitativas y para variables cualitativas se aplicó la prueba de Chi2. Se utilizó Kaplan Meier para analizar el tiempo de llanto total. Resultados: se analizaron un total de 144 pacientes, 48 por grupos. El grupo de LM tuvo menor tiempo de llanto (p = 0,007) y menor calificación de dolor a los 90 (p = 0,006) y 120 (p = 0,003) segundos comparado con los otros 2 grupos. Mientras que entre el grupo SL y el grupo control no hubo diferencia significativa en la duración del llanto ni la escala de dolor. Conclusiones: la lactancia materna es efectiva para el manejo del dolor agudo después de la vacunación en lactantes menores de 6 meses de edad en comparación al sucedáneo de leche y no aplicar analgesia.