A Multidimensional Approach to Pain Assessment in Critically Ill Infants During a Painful Procedure

Manon Ranger, C. Celeste Johnston, Janet E. Rennick, Catherine Limperopoulos, Thomas Heldt, Adré J. du Plessis
2013 The Clinical Journal of Pain  
Objectives-Inferring the pain level of a critically ill infant is complex. The ability to accurately extract the appropriate pain cues from observations is often jeopardized when heavy sedation and muscular blocking agents are administered. Near-infrared spectroscopy (NIRS) is a noninvasive method that may provide the bridge between behavioral observational indicators and cortical pain processing. We aimed to describe regional cerebral and systemic hemodynamic changes, as well as behavioral
more » ... tions in critically ill infants with congenital heart defects (CHD) during chest drain removal following cardiac surgery. Methods-Our sample included 20 critically ill infants with CHD less than 12 months of age admitted to the cardiac intensive care unit following surgery. Results-Cerebral deoxygenated hemoglobin concentrations significantly differed across the epochs (i.e. Baseline, Tactile stimulus, Noxious stimulus) (p = .01). Physiological systemic responses and FLACC pain scores differed significantly across the events (p < .01). The three outcome measures were not found to be associated with each other. Mean FLACC pain scores during the painful procedure was 7/10 despite administration of morphine. Midazolam administration accounted for 36% of the variance in pain scores. Discussion-We demonstrated with a multidimensional pain assessment approach that significant cerebral, physiological and behavioral activity was present in response to a noxious
doi:10.1097/ajp.0b013e31826dfb13 pmid:23328334 pmcid:PMC3640737 fatcat:zj42spnekzcbtodev7ngjrv6tu