The Effect of Upper Limb Massage on Infants’ Venipuncture Pain

doi:10.1016/j.pmn.2016.10.001

Pain Management Nursing

Volume 18, Issue 1, February 2017, Pages 50-57

https://doi.org/10.1016/j.pmn.2016.10.001 Get rights and content

Abstract

The purpose of the study was to investigate the effect of upper limb massage on relieving pain among infants undergoing venipuncture in Hong Kong. This study was a crossover, double-blind, randomized controlled trial. Eighty infants at the neonatal intensive care unit were randomly assigned to 2 groups in different order to receive interventions. The massage first group (N = 40) received 2-minute massage before venipuncture on the first occasion then received usual care (control) on the second occasion, and vice versa in the massage second group (N = 40). The infants' behavior and physiological responses were recorded on two occasions: (1) right after the intervention and (2) during the first 30 seconds of venipuncture procedure. The mean pain scores (Premature Infant Pain Profile) were significantly lower in infants who received massage (massage first: 6.0 [standard deviation = 3.3]; massage second: 7.30 [standard deviation = 4.4]) versus control (massage first: 12.0 [standard deviation = 4.3]; massage second: 12.7 [standard deviation = 3.1]). The crude and adjusted generalized estimating equations model showed that the infants had significantly lower pain score when receiving massage as compared to receiving the control treatment, and there were no significant time and carryover effects: −6.03 (95% confidence interval: −7.67 to −4.38), p < .001 and −5.96 (95% confidence interval: −7.56 to −4.36), p < .001, respectively. Upper limb massage may be effective in decreasing infants' venipuncture pain perception.

Section snippets

Literature Review

Few studies have reported the prevalence of invasive procedures experienced by infants during their hospitalization. In determining the magnitude of pain responses to nursing/medical procedures among 135 infants, Porter et al. (1999) found that infants who were born between 33 and 36 weeks of gestation underwent an average of nearly 60 painful procedures during hospitalization. The situation is even worse in infants whose gestational age is less than 28 weeks, as the average number of

Methods

The infants in this study were recruited at the NICU in a regional hospital of Hong Kong. The study was commenced after receiving local ethical committee approval and consent from the parents.

Results

The parents of 91 eligible infants were invited to participate in the study; the parents of 11 infants refused to participate or thereafter could not be contacted. Therefore, 80 infants participated in the study, with 15 being eliminated due to not needing a second blood sampling. The sample accrual and flow is shown in Figure 2.

Discussion

The present study demonstrated that upper limb massage was associated with a significant reduction in pain scores for infants in pain due to venipuncture. There was a difference in pain scores between infants who had a massage intervention and those who had not had a massage intervention. According to a study by Pasero (2002), a total PIPP score of 0 is considered to reflect no pain, 6 or less is considered to reflect minimal pain, 7 to 12 indicates moderate pain, and a total score that is

Conclusion

In this study, limb massage was studied in relation to pain relief in infants undergoing venipuncture. Massage is not a common nonpharmacological intervention for procedural pain in infants, but it is recommended as a method of pain management, because the study results show that infants with a gestational age between 30 and 40 weeks can benefit from limb massage to reduce pain from venipuncture.

Acknowledgments

We thank all the parents and infants who participated in this study. We also thank the nurses in the NICU, United Christian Hospital, for their helpful assistance.

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Containment holding, the caregiver can use both hands to hold the baby and make the baby feel safe (one hand on the baby's head, the other hand on the baby's feet) (The Royal Children's Melbourne Hospital, (http://www.rch.org.au, March 25, 2017). Chik YM, Ip WY, Choi KC., (2017) stated that massage of upper limbs could be an efficient technique in reduction of venipuncture pain as it reduced pain manifestation behavior. Pain scores were measured by PIPP revealing the scores of 5.84 and 7.30 in the massage and control groups, respectively, which are consistent with the findings of the present study.
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: This manuscript has not been published before. Ms. Yuen-Man Chik, Ms. Wan-Yim Ip, and Mr. Kai-Chow Choi have no conflicts of interest to disclose.

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Original ArticleThe Effect of Upper Limb Massage on Infants’ Venipuncture Pain

Abstract

Section snippets

Literature Review

Methods

Results

Discussion

Conclusion

Acknowledgments

Infant Behavior and Development

Pain Management Nursing

Infant Behavior & Development

Infant Behavior and Development

Seminars in Fetal & Neonatal Medicine

Early Human Development

Pain

The relationship between behavioral states and pain responses to various NICU procedures in premature infants

Journal of Tropical Pediatrics

Individualized developmental care for the very low-birth-weight preterm infant: Medical and nuerofunctional effects

Journal of the American Medical Association

Can adverse neonatal experiences alter brain development and subsequent behavior?

Biology of the Neonate

A randomized placebo-controlled trial of massage therapy on the immune system of preterm infants

Pediatrics

Validation of the premature infant pain profile in the clinical setting

The Clinical Journal of Pain

Exposure to invasive procedures in neonatal intensive care unit admissions

Archives of Disease in Childhood

Sensorial saturation for neonatal analgesia

The Clinical Journal of Pain

Exploring barriers to pain management in newborn intensive care units: A pilot survey of NICU nurses

Advances in Neonatal Care

Epidemiology and treatment of painful procedures in neonates in intensive care units

The Journal of the American Medical Association

Stable preterm infants gain more weight and sleep less after five days of massage therapy

Journal of Pediatric Psychology

Longitudinal comparison of preterm pain responses to repeated heelsticks

Pediatric Nursing

Efficacy and safety of sucrose for procedural pain relief in preterm and term neonates

Nursing Research

Pain management in nursing procedures on premature babies

Journal of Advanced Nursing

Impact of massage therapy on motor outcomes in very low-birthweight infants: Randomized controlled pilot study

Pediatrics International

Non-pharmacological analgesia: Effective but underused

Archives of Disease in Childhood

Prior leg massage decreases pain responses to heel stick in preterm babies

Journal of Paediatrics & Child Health

Original Article
The Effect of Upper Limb Massage on Infants’ Venipuncture Pain