Massagem para alívio da dor em recém-nascidos submetidos a punção: revisão sistemática com metanálise

Abstract

Introduction: Premature newborns are exposed to about 75.1 ± 42.6 painful procedures during hospital stay, which generate an impact on changes in blood pressure, heart rate and respiratory rate, and it is necessary to apply measures that relieve pain. Non-pharmacological treatments are currently an effective alternative in pain management, since they mitigate neonatal suffering and reduce the chances of future comorbidities. Massage is part of these non-pharmacological measures, which is based on the comfort and relaxation of the individual, since it is linked to the improvement of blood circulation, reinforcing oxygenation and nutrition of tissues, having important efficacy in reducing pain. Objective: To analyze the effects of massage on pain relief in newborns undergoing puncture. Method: It is a systematic review with meta-analysis, with the research question by the PICO strategy (Patient or Problem, Intervention, Control or Comparasion, Outcomes): Does massage produce pain relief when used in newborns undergoing puncture? The National Library of Medicine, Web of Science, Cumulative Index to Nursing and Allied Health Literature, SciVerse Scopus, Cochrane Library and Gale Academic OneFile were searched. Different combinations of the keywords “infant, newborn”, “massage”, “pain” were used. The crossing of the search descriptors indexed in the MesH were: ((((infant, newborn) OR (premature) OR (baby)) AND ((massage) OR (reflexotherapy)) AND ((pain) OR (Pain measurement) OR (Pain management) OR (Pain relief) OR (Pain assessment) OR (Puncture))). Primary quasi-experimental studies and a randomized clinical trial, which evaluated pain in newborns submitted to puncture using massage, were included. The research was carried out without language restriction and without time frame. This review was submitted to the International Prospective Register of Systematic Reviews database under number CRD42021226313. Results: Of the 878 studies found, after reading titles and abstracts, deleting duplicates and reading in full, the sample consisted of 12 articles. A high level of agreement was observed among the reviewers who tracked the articles (Kappa index>90%). Of the 12 records included in this review, 11 (91.6%) randomized clinical trials and one (8.3%) is characterized as a non-randomized clinical trial (almost experimental study). Regarding the specifications of the study population, the total number of participants enrolled in the studies was 981 neonates, and the age varied between 24 hours of life and 42 gestational weeks. About the place of application, seven (58.3%) studies performed the intervention in the lower limbs; five (41.6%) in the upper limbs; and five (41.6%) in the newborns' feet. Regarding the time of application, seven (58.3%) studies performed massage for 2 minutes; two (16.6%), for 3 minutes; one (8.3%), for 1 minute; and one (8.3%) for 30 minutes. The instruments most used by researchers to evaluate the response to pain felt by newborns were the Neonatal Infant Pain Scale and the Premature Infant Pain Profile. The researchers identified the effectiveness of massage over other techniques (or control group) in pain relief in 83.3% of the studies. The main benefits generated by the massage were: reduction of pain scores during and after puncture, better mental development, lower heart rate change, shorter duration of crying and shorter procedure time. Most of the sample was classified as a risk of uncertain bias due to lack of information about the process of execution of the study. The comparative meta-analysis of massage versus routine care that evaluated the pain score was not statistically significant. On the other hand, the comparative meta-analysis of massage versus routine care that evaluated the duration of crying obtained a statistically significant result (p = 0.0002). Conclusion: The application of massage can contribute to the relief of neonatal pain by reducing the pain assessment score, reducing crying time and stabilizing vital signs in newborns submitted to puncture.