A Neonatal Nurse-Controlled Model of Analgesia to Manage Post-Operative Pain in the Surgical Neonate: A Pilot Randomised Controlled Trial.
Renee Muirhead, Kathryn Kynoch, Glenda Hawley and 3 others
PMID 40270436WHAT IT FOUND
Nurse-controlled neonatal analgesia was feasible in parts but not fully: staff found pathways useful but hard to follow, pain scoring often missed, and recruitment fell short.
The pilot did not establish whether this model reduces infant pain or improves recovery.
Key findings
01The pilot did not meet its main feasibility targets: overall compliance with all aspects of the intervention was achieved for one (9%) infant, and the portion of potentially eligible infants not recruited did not meet the less than 20% target.
02Twenty-two nursing staff completed the acceptability survey; nineteen reported that formalised escalation guidelines were beneficial, while fourteen respondents felt the model was not easily followed.
03Secondary outcomes, not the primary outcome, reported intervention medians of 1.6 versus 1.9 for pain in the first 3 days, 55 versus 92 hours to cessation of analgesics, 13 versus 18 days length of stay, 1541 versus 1190 micrograms opioid consumption, and 39 versus 25 hours ventilation.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a pilot study designed to test feasibility and acceptability, not effectiveness, and it was not powered to show whether the model reduced pain or improved recovery. The sample was small and analysed after exclusions: 24 infants were randomised, but secondary outcome tables report 11 infants in each group. The study was single-centre and unblinded, so nurses and families knew the allocation, which can affect comfort care, analgesia requests and pain scoring. Adherence to the intervention was poor, with incorrect pain scoring frequency, failure to reassess after analgesia changes, delayed weaning and inconsistent documentation of comfort measures. Recruitment was incomplete because eligible infants were not notified to research staff or researchers were unavailable, and the missed recruitment target means the model cannot yet be taken forward unchanged. The intervention combined nurse-controlled morphine titration, paracetamol, non-pharmacological comfort measures and parental presence, so any single component cannot be credited for secondary outcome differences. Staff acceptability was mixed: nineteen staff valued formalised escalation guidance, but fourteen respondents said the model was not easily followed. Parental involvement was limited in practice; only one parent in the intervention group reported being asked to be present to comfort the infant. Secondary outcomes were mixed and descriptive, with lower pain scores and shorter analgesic cessation in the intervention group but higher opioid consumption and longer ventilation time.
Declared interests
The supplied text states only that the authors declared no conflicts of interest; it does not report who funded the study.
The easy way to misread this
Do not conclude that nurse-controlled analgesia reduces post-operative pain or improves recovery. The trial was a pilot whose primary outcomes were feasibility and acceptability, not effectiveness. Secondary results were mixed, with lower pain scores and shorter analgesic cessation in the intervention group but higher opioid consumption and longer ventilation time. The intervention included nurse-controlled morphine, paracetamol, non-pharmacological comfort measures and parental presence, so one component cannot be credited.