Glicose 25% e reflexoterapia no alívio da dor em neonatos submetidos à punção arterial: ensaio clínico randomizado

Abstract

Newborns are exposed to a range of painful procedures in the Neonatal Intensive Care Unit, and pain relief measures are necessary. Non-pharmacological treatment of neonatal pain seeks to reduce aggressive stimuli in the environment, prevent physiological and behavioral changes, generate comfort and reduce stress during hospitalization. In this perspective, this study aims to compare the effect of 25% glucose solution and reflexology in relieving pain in newborns undergoing arterial puncture admitted to the Neonatal Intensive Care Unit. This is a randomized, controlled, double-blind clinical trial conducted with newborns who had an indication for blood collection by arterial puncture and were admitted to a neonatal intensive care unit of a maternity hospital that is a reference for high-risk pregnancies and deliveries in Natal, Rio Grande do Norte. The sample consisted of 40 patients, 20 of whom were in the Control Group who received the oral glucose solution 25%, and 20 patients in the Experimental Group who received foot reflexology. The inclusion criteria for the study were: newborns up to one week old who were born at ≥ 32 weeks of gestational age or weighing >1500g who underwent collection of laboratory tests/blood gas analysis/blood culture through arterial puncture. To evaluate the effectiveness of the interventions applied, a data collection instrument was used, structured in three parts: data from the mother; data related to the birth and the newborn; assessment of pain during the arterial puncture procedure using the Neonatal Infant Pain Scale (NIPS) and other parameters. The primary outcome of the study was neonatal pain scores before, during and after arterial puncture. Secondary outcomes were crying time, oxygen saturation and heart rate of the newborns before, during and after the arterial puncture procedure. The data were processed in a Microsoft Office Excel 2020 software database to create descriptive tables and to apply statistical tests, the Statistical Package for the Social Sciences version 25.0 was used, through descriptive and inferential statistics. To compare the control and experimental groups, the Chi-square, Student's t-test and Analysis of Variance for repeated measures were applied, with p<0.05 for the relationship between the variables. The project was approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte, CAAE 23720419.5.0000.5537 and was registered in the Brazilian Registry of Clinical Trials under number RBR-639bff. Regarding the results, the effectiveness of the foot reflexology intervention was proven when compared to the use of 25% glucose in reducing pain scores after the procedure and stabilizing vital signs. Regarding the primary outcomes, when comparing the two interventions, a significant reduction in pain scores (NIPS: 0.70) was observed in the experimental group after the painful procedure. As for the secondary outcomes, it was observed that crying time was shorter in the experimental group, and oxygen saturation also showed higher values in the reflexology group during and after the procedure. The heart rate remained within normal values and more stable (lower values) in the experimental group. Thus, the alternative hypothesis is confirmed and the proposed thesis is proven, since the findings identified in the experimental group indicated that the interventions performed caused significant effects and the Experimental Group showed a reduction in pain scores and stabilization of vital signs, thus proving the effectiveness of reflexology in relieving pain in neonates undergoing painful procedures. Finally, the results of this study contribute to the acquisition and increase of knowledge related to the use of reflexology as a complementary integrative health practice in relieving neonatal pain in patients hospitalized in the NICU. Reflexology is expected to be incorporated into hospital institutions as a way of promoting health and improving neonatal care.