Non-pharmacological techniques for pain management in neonates.

Significant progress in understanding the physiology, clinical correlates, and consequences of neonatal pain have resulted in greater attention to pain management during neonatal intensive care. A number of nonpharmacological therapies have been investigated, including nonnutritive sucking, with and without sucrose use, swaddling or facilitated tucking, kangaroo care, music therapy, and multi-sensorial stimulation. Although the efficacy of these approaches is clearly evident, they cannot provide analgesia for moderate or severe pain in the neonate. Further, some of these therapies cannot be effectively applied to all populations of critically ill neonates. Acupuncture, an ancient practice in Chinese medicine, has gained increasing popularity for symptom control among adults and older children. Acupuncture may provide an effective nonpharmacological approach for the treatment of pain in neonates, even moderate or severe pain, and should be considered for inclusion in a graduated multidisciplinary algorithm for neonatal pain management.

Intraoperative acupuncture for posttonsillectomy pain: a randomized, double-blind, placebo-controlled trial.

OBJECTIVES/HYPOTHESIS: To evaluate the effect of intraoperative acupuncture on posttonsillectomy pain in the pediatric population. STUDY DESIGN: Prospective, double-blind, randomized, placebo-controlled trial. METHODS: Patients aged 3 to 12 years undergoing tonsillectomy were recruited at a tertiary children's hospital between February 2011 and May 2012. Participants were block-randomized to receive acupuncture or sham acupuncture during anesthesia for tonsillectomy. Surgeons, staff, and parents were blinded from treatment. Tonsillectomy was performed by one of two surgeons using a standard technique (monopolar cautery), and a single anesthetic protocol was followed. Study endpoints included time spent in the postanesthesia care unit, the amount of opioids administered in the perioperative period, and pain measures and presence of nausea/vomiting from postoperative home surveys. RESULTS: Fifty-nine children aged 3 to 12 years were randomized to receive acupuncture (n = 30) or sham acupuncture (n = 29). No significant demographic differences were noted between the two cohorts. Perioperative data were recorded for all patients; 73% of patients later returned home surveys. There were no significant differences in the amount of opioid medications administered or total postanesthesia care unit time between the two cohorts. Home surveys of patients but not of parents revealed significant improvements in pain control in the acupuncture treatment-group postoperatively (P = 0.0065 and 0.051, respectively), and oral intake improved significantly earlier in the acupuncture treatment group (P = 0.01). No adverse effects of acupuncture were reported. CONCLUSIONS: This study demonstrates that intraoperative acupuncture is feasible, well tolerated, and results in improved pain and earlier return of diet postoperatively. LEVEL OF EVIDENCE: 1b.

The use of dexmedetomidine during laryngoscopy, bronchoscopy, and tracheal extubation following tracheal reconstruction.

We report the use of dexmedetomidine for laryngoscopy, rigid bronchoscopy, and tracheal extubation in the operating room in two children who had undergone tracheal reconstruction 1 week previously. Dexmedetomidine in combination with propofol provided appropriately deep anesthesia during these brief but stimulating procedures without cardiovascular or respiratory depression.