在三级新生儿重症监护环境中常规使用静脉切割止痛药:质量改善研究
Sonam Shah1, Dwayne Mascarenhas2, Medha Goyal3
1Department of Neonatology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India.
Biomedicine hub
|June 18, 2025
概括
随着质量改善倡议,静脉穿刺期间的新生儿疼痛管理得到了显著改善. 常规止痛药的使用从0%增加到50%以上,降低了长期疼痛敏感性风险.
科学领域:
- 新生儿护理 新生儿护理
- 疼痛管理 疼痛管理
- 提高质量 提高质量
背景情况:
- 新生儿接触疼痛可以改变未来的疼痛感知.
- 对于诸如静脉穿刺等痛苦的手术,常规使用止痛药是缺乏的.
- 静脉切除是新生儿重症监护室中常见的,但痛苦的手术.
研究的目的:
- 实施质量改进 (QI) 研究,以增加新生儿静脉穿刺期间止痛的使用.
- 为了改善经过静脉穿刺的新生儿的常规疼痛缓解措施的管理.
主要方法:
- 一个鱼骨分析发现了止痛药使用的障碍.
- 计划-做-研究-行动 (PDSA) 循环被采用,包括提供者教育,以及使用母亲自己的牛奶,捐赠者牛奶和25%的乳糖.
- 干预措施在8周内实施,随后对持续使用进行监测.
主要成果:
- 在PDSA循环结束时,止痛药的使用量从基线的0%增加到53%.
- 在干预后,止痛药的使用率达到60%,持续了3个月.
- 该QI模型成功地识别并解决了有效疼痛管理的障碍.
结论:
- 一种QI方法有效地增加了新生儿静脉穿刺期间的止痛使用.
- 该研究表明,疼痛管理实践的文化变化取得了成功.
- 实施多模式止痛策略对于减轻新生儿疼痛至关重要.
相关概念视频
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
606
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
One of the advantages of...
606
Local Anesthetics: Clinical Application as Epidural Anesthesia
509
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
509
Analgesia and Pain Management
823
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
823
Local Anesthetics: Clinical Application as Spinal Anesthesia
821
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
821


