Purpose: to verify the frequency and the profile of the use of analgesic drugs in
potentially painful procedures in newborn infants interned in two neonatal intensive care units of Belem-PA. Methods: a prospective cohort study was performed in two institutions, one private and another public and academic, during two months of 2006. Demographic data, clinical morbity, invasive procedures, postoperative period, mechanical ventilation and the use of analgesic drugs were studied. Descriptive statistical analysis and multiple linear regression by using SPSS 13.0 software was performed. Results: 82 patients were studied, comprehending 951 patient-days, where only 21% (201 patient-days) received some analgesic dose. The most frequent procedure was the capillary puncture (43.1%), followed by endotracheal suctioning (30.3%). Only 24.1% of the invasive procedures received analgesia. The frequency in each procedure was: 18.1% in capillary punctures, 21.1% in arterial punctures, 15% in venous punctures, 36.3% in endotracheal suctionings and 24.3% in intubations procedures. There was no use of analgesia in lumbar punctures. Flebotomies were performed with local anesthesic in 100% of the cases. Mechanical ventilation and the postoperative period were associated to the largest use of analgesia. Fentanyl was the drug administered in all the cases of systemic analgesia. The Institution A used more analgesia (30% of the patient-days) compared to the Institution B (15% of the patient days). Besides, there was a larger use of analgesic drugs in the procedures in the institution A, compared to B, when the newborn infant was under mechanical
ventilation. In the Institution B, the use of analgesia in the procedures was larger,
compared to A, when the newborn infant was in the postoperative period. The chance of a newborn infant from Institution B to receive analgesia compared to Institution A is 53% smaller to capillary puncture, 61% smaller to arterial puncture, 87% smaller to endotracheal suctioning and 80% larger to venous puncture after adjustment to gestational age and weight at birth. The intubation procedures showed an analgesia receipt chance similar between both Institutions. Conclusion: The insertion of the neonatal pain study in the medical graduation is an urgent necessity under a medical, ethical and humanitarian point of view so that the negative effects of pain can be avoided and a better quality of life to the critically ill newborn infants can be ensured.
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