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Morphine and topical anesthesia found effective in treating pain in newborn infants
February 15, 2006Intravenous morphine used alone or with topical tetracaine effectively reduced levels of pain in preterm newborn infants undergoing central line insertion procedures, according to a study in the February 15 issue of JAMA.
About 10 percent to 15 percent of newborns require prolonged hospitalization for conditions such as preterm birth, birth defects, and sepsis (a blood stream infection). As part of their medical care, they are often exposed to multiple invasive procedures that may be painful. There is accumulating evidence that untreated procedural pain in newborns leads to long-term changes in pain sensitivity, according to background information in the article. The effectiveness of local or systemic analgesics (pain relievers) to minimize pain in newborns during certain procedures is not clear.
Anna Taddio, Ph.D., of the Hospital for Sick Children and University of Toronto, and colleagues studied the relative efficacy and safety of topical local anesthesia (tetracaine) and intravenous opioid analgesia (morphine), used alone or in combination, for management of pain in newborns undergoing the insertion of a central venous catheter. The randomized, double-blind, controlled trial, conducted between October 2000 and July 2005, included 132 ventilated newborns (average gestational age, 30.6 weeks at study entry). Prior to catheter insertion, the newborns were randomly assigned to receive tetracaine (n = 42), morphine (n = 38), or both (n = 31); a separate nonrandomized group of 21 neonates receiving neither tetracaine nor morphine was used as a control group.
The researchers determined pain scores by measuring the proportion of time newborns displayed facial grimacing (brow bulge) during different phases of the procedure (skin preparation, needle puncture, and recovery).
The authors found that the combination of morphine (opioid analgesia) and tetracaine (local anesthesia) was more effective than either local anesthesia alone or no analgesia in reducing the pain of catheter placement, but similar in effectiveness to opioid analgesia alone. Local anesthesia alone, however, was not consistently different from no analgesia, suggesting that it was a weak analgesic.
"We hypothesize that morphine was more effective than tetracaine because morphine reduced the sensory input derived from multiple phases of the procedure that differed in both the location and degree of invasiveness, whereas tetracaine decreased sensation from the needle puncture site," they write.
Concerning adverse events, morphine caused respiratory depression and tetracaine caused erythema (abnormal redness of skin).
"These findings are consistent with the underlying mechanisms of action for both drugs," the researchers write. "These data can be used to support evidence-based protocols for the pharmacologic management of pain during percutaneous central venous catheter placement in ventilated neonates," the researchers conclude.
JAMA and Archives Journals
The researchers determined pain scores by measuring the proportion of time newborns displayed facial grimacing (brow bulge) during different phases of the procedure (skin preparation, needle puncture, and recovery).
The authors found that the combination of morphine (opioid analgesia) and tetracaine (local anesthesia) was more effective than either local anesthesia alone or no analgesia in reducing the pain of catheter placement, but similar in effectiveness to opioid analgesia alone. Local anesthesia alone, however, was not consistently different from no analgesia, suggesting that it was a weak analgesic.
"We hypothesize that morphine was more effective than tetracaine because morphine reduced the sensory input derived from multiple phases of the procedure that differed in both the location and degree of invasiveness, whereas tetracaine decreased sensation from the needle puncture site," they write.
Concerning adverse events, morphine caused respiratory depression and tetracaine caused erythema (abnormal redness of skin).
"These findings are consistent with the underlying mechanisms of action for both drugs," the researchers write. "These data can be used to support evidence-based protocols for the pharmacologic management of pain during percutaneous central venous catheter placement in ventilated neonates," the researchers conclude.
JAMA and Archives Journals
Morphine Current Events and Morphine News RSSCommon pain relief medication may encourage cancer growth
Although morphine has been the gold-standard treatment for postoperative and chronic cancer pain for two centuries, a growing body of evidence is showing that opiate-based painkillers can stimulate the growth and spread of cancer cells.
Chronic pain treatments work better together, says Queen's anesthesiologist
People who suffer from debilitating neuropathic pain may get more relief and sleep better by combining two commonly-prescribed drugs.
Infant pain, adult repercussions
Scientists at Georgia State University have uncovered the mechanisms of how pain in infancy alters how the brain processes pain in adulthood.
Nanoparticle-based battlefield pain treatment moves step closer
University of Michigan scientists have developed a combination drug that promises a safer, more precise way for medics and fellow soldiers in battle situations to give a fallen soldier both morphine and a drug that limits morphine's dangerous side effects.
Researchers explore long-term adolescent vulnerability to drugs
As part of efforts to understand drug abuse, Georgia State University researchers are finding that adolescent rats appear to be less vulnerable to the long-term effects of withdrawal and relapse in certain types of drug use than rats that take the drugs in adulthood.
Researchers find genetic link between physical pain and social rejection
UCLA psychologists have determined for the first time that a gene linked with physical pain sensitivity is associated with social pain sensitivity as well.
Chinese acupuncture affects brain's ability to regulate pain, UM study shows
Acupuncture has been used in East-Asian medicine for thousands of years to treat pain, possibly by activating the body's natural painkillers. But how it works at the cellular level is largely unknown.
Fish may actually feel pain and react to it much like humans
Fish don't make noises or contort their faces to show that it hurts when hooks are pulled from their mouths, but a Purdue University researcher believes they feel that pain all the same.
Hebrew University researchers show how morphine can be given more effectively
Researchers at the Hebrew University of Jerusalem have found a way to maintain the pain-killing qualities of morphine over an extended period of time, thus providing a solution for the problem of having to administer increasing dosages of the drug in order to retain its effectiveness.
Mayo Clinic study suggests those who have chronic pain may need to assess vitamin D status
Mayo Clinic research shows a correlation between inadequate vitamin D levels and the amount of narcotic medication taken by patients who have chronic pain.
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