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Effects of Massage on Postoperative Pain in Infants With Complex Congenital Heart Disease
Tondi M Harrison1, Roger Brown, Travis Duffey
1Tondi M. Harrison, PhD, RN, FAAN, is Associate Professor, The Ohio State University College of Nursing, Columbus. Roger Brown, PhD, is Professor, University of Wisconsin-Madison School of Nursing. Travis Duffey, LMT, is Licensed Massage Therapist, Nationwide Children's Hospital, Columbus, Ohio. Corrie Frey, LMT, CIMI, CPMT, is Licensed Massage Therapist, Nationwide Children's Hospital, Columbus, Ohio. Jacob Bailey, BSN, RN, is Staff Nurse, COPC Ohio Center for Pediatrics, Dublin. Marliese Dion Nist, PhD, RNC, is Postdoctoral Fellow, The Ohio State University College of Nursing, Columbus, Ohio. Lauren Renner, MSN, RN, CPNP, is APRN Clinical Leader, Nationwide Children's Hospital, Columbus, Ohio. Jill Fitch, MD, is Pediatric Intensivist, Nationwide Children's Hospital, Columbus, OH.
Insights
Postoperative massage in infants with complex congenital heart disease (CCHD) showed reduced pain scores and improved physiological responses like heart rate and respiratory rate. This nonpharmacological approach may benefit CCHD infants by easing cardiorespiratory demand.
Area of Science:
- Pediatric Cardiology
- Pain Management
- Nonpharmacological Interventions
Background:
- Pain management is crucial for pediatric surgical patients.
- Massage has shown efficacy in adult pain management but is understudied in infants with complex congenital heart disease (CCHD).
Purpose of the Study:
- To evaluate the effectiveness of massage versus a rest period on postoperative pain and physiological responses in infants with CCHD.
Main Methods:
- A randomized clinical trial involving 60 infants (1 day to 12 months) with CCHD post-cardiothoracic surgery.
- Interventions included a 30-minute daily massage or quiet time for seven days.
- Pain assessed using FLACC scale; physiological data (HR, RR, SpO2) and analgesic doses recorded.
Main Results:
- The massage group exhibited lower daily pain scores (Days 4-6) and reduced average daily heart rate and respiratory rate.
- Infants showed immediate positive physiological responses to massage, including decreased HR and RR, and increased SpO2.
- No significant group effect on overall pain level or rate of change, but consistent trends favored massage.
Conclusions:
- Postoperative massage offers preliminary evidence of reduced pain and improved physiological parameters in infants with CCHD.
- This nonpharmacological adjunct may benefit CCHD patients by decreasing cardiorespiratory system demand.
Background:
Pain management is an essential component of care for pediatric patients following surgery. Massage reduces self-reported postoperative pain in adults with heart disease but has received little attention in postoperative pediatric patients with complex congenital heart disease (CCHD).
Objectives:
The aim of the study was to evaluate the effectiveness of massage compared to a rest period on postoperative pain scores and physiological responses in infants with CCHD.
Methods:
We used a two-group randomized clinical trial design with a sample of 60 infants with CCHD between 1 day and 12 months of age following their first cardiothoracic surgery. Both groups received standard postoperative care. Group 1 received a daily 30-minute restriction of nonessential caregiving (quiet time), and Group 2 received a daily 30-minute massage. Interventions continued for seven consecutive days. Pain was measured six times daily using the Face, Legs, Activity, Cry, Consolability Pain Assessment Tool (FLACC). Average daily doses of analgesics were recorded. Heart rates (HRs), respiratory rates (RRs), and oxygen saturations (SpO2) were recorded continuously. Daily averages, pre- and postintervention FLACC scores, and physiological responses were analyzed using descriptive statistics, generalized linear mixed models repeated measures, latent growth models, and/or regression discontinuity analysis. Fentanyl-equivalent narcotic values were used as a time-varying covariate.
Results:
Adjusted pain scores were lower for the massage group on all days except Day 7. Overall, there were no group effects on level of pain or differential rate of change in pain. However, the massage group had lower daily pain scores with small to medium effect size differences, largest at Days 4, 5, and 6, and lower average daily HR and RR. There was little difference between groups in SpO2. Infants demonstrated immediate effects of massage, with HR and RR decreasing and oxygen saturations increasing.
Discussion:
This study provides beginning evidence that postoperative massage may reduce pain and improve physiological parameters in infants with congenital heart disease. This nonpharmacological adjunct to pain management may provide a particular benefit for this population by reducing demand on the cardiorespiratory system.
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