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CONTEXT: The subjectivity of pain causes enormous difficulties in evaluating neonatal pain with a single, practical and easy-to-apply tool. Pain evaluation in the neonatal period should be performed by valid, safe, useful and feasible methods. OBJECTIVE: To evaluate the validity of the Neonatal Facial Coding System (NFCS), Neonatal Infant Pain Scale (NIPS), heart rate (HR) and O2 saturation (O2 sat) for neonatal pain assessment. DESIGN: Prospective, double-blind randomized trial. SETTING: A secondary level maternity hospital. PARTICIPANTS: 70 healthy neonates requiring bilirubin dosage were randomly assigned to receive a venous puncture (P: n=33, BW 3.2kg, SD 0.6; GA 39wk, SD 1; 59h of life, SD 25) or an alcohol swab friction (F: n=37; BW 3.1kg, SD 0.5; GA 39wk, SD 1; 52h of life, SD 17). INTERVENTION: All measurements were taken prior to (PRE), during (T0), and 1(T1), 3(T3), 5(T5) and 10(T10) minutes after the procedure. MEASUREMENTS: A neonatologist evaluated NFCS, NIPS, HR and O2 sat by pulse oxymetry. RESULTS: Median NFCS and NIPS results at T0, T1 and T3 were higher in P group, compared to F. More P neonates presented NFCS >2 and/or NIPS >3 at T0, T1 and T3. HR was lower in P group at T1. Average O2 sat was above 90% during the whole study period in both groups. CONCLUSION: NFCS and NIPS are suitable instruments for neonatal pain evaluation. Heart rate and O2 saturation can be used only as auxiliary methods. CONTEXTO: A subjetividade da dor gera uma grande dificuldade para a elaboração de um método único de avaliação e de fácil aplicação na clínica diária. Os métodos para a avaliação da dor no período neonatal devem ser válidos, seguros, confiáveis, úteis e exeqüíveis.OBJETIVO: verificar a validade do Sistema de Codificação da Atividade Facial Neonatal (NFCS), Escala de Dor para o RN (NIPS), freqüência cardíaca (FC) e saturação de oxigênio (SatO2) para a avaliação da dor no recém-nascido (RN). TIPO DE ESTUDO: prospectivo, duplo-cego e randomizado. LOCAL: maternidade de nível secundário. PARTICIPANTES: 70 RN a termo saudáveis, com punção venosa para bilirrubina, divididos em dois grupos: P (n=33) recebeu um estímulo doloroso (punção) e F (n=37) um desagradável (fricção na mão). INTERVENÇÃO: observação do NFCS, da NIPS, da FC e da SatO2, antes (PRÉ), durante (T0) e 1(T1), 3(T3), 5(T5) e 10(T10) minutos após P ou F. MENSURAÇÃO: testes não paramétricos (significância: p2 e/ou NIPS >3 em T0, T1 e T3. A FC foi inferior no Grupo P em T1. A SatO2 manteve-se, em média, acima de 90% nos dois grupos. CONCLUSÕES : o NFCS e a NIPS são válidos para a avaliação da dor aguda no RN a termo. A FC e a SatO2 devem ser utilizadas como coadjuvantes.

The purpose of this study was to verify if multidimensional pain assessment, performed through physiologic and behavioral measures, together with this assessment modifications in response to opioid analgesia, could determine the presence of pain in preterm neonates (PT) under mechanical ventilation through endotracheal tube (ETT). The population consisted of 22 PT with gest. age < or = 32 weeks, between 12-48 h of life. All of them had an ETT and an umbilical arterial line in place and were on mechanical ventilation. The infants were admitted at Sao Paulo Hospital NICU from 11/91 to 11/92. Neonates' observation was performed in three 10 minute periods: prior medication (Pre-Analgesia), 30 min (Analgesia 1) and 60 min (Analgesia 2) after the injection of either fentanyl (3 mcg/kg) or sterile water (0.2 ml). In each period an arterial blood gas was drawn and the following parameters were recorded: ventilator settings, heart rate, non-invasive blood pressure and 02 saturation. Behavioral measures were also observed: ATTIA scale, MCGRATH scale and GRUNAU & CRAIG pain facial features. In Pre-Analgesia and Analgesia 2 periods, blood samples were obtained and serum cortisol, serum GH, plasmatic glucose and lactate were measured. Patients were filmed through the study and behavioral measures applied for each patient film. The research author was blind to the medication until final results. High levels of serum cortisol, serum GH and plasmatic lactate were present in the whole study population prior to medication. They also presented low ATTIA scale scores and pain facial mimic, as per MCGRATH and GRUNAU & CRAIG evaluations. Patients that received fentanyl exhibited decrease in the maximum heart rate, decrease in serum cortisol, increase in serum GH, stability in blood glucose levels, better ATTIA scale comfort scores and less pain facial movements. None of these occurred in neonates that received placebo. Critically ill intubated and ventilated PT do feel pain, as assessed by this multidimensional evaluation. Analgesia should be considered in order to treat these patients' pain.

The present study aimed to assess the effects of low-level laser (660 nm) on myonecrosis caused by the insertion of Bothrops neuwiedi venom in the gastrocnemius muscle of rats. Male Wistar rats were divided into three groups (n = 24 each): Group S (0.9% saline solution); Group V (venom) and Group VLLL (venom plus low-level laser). These categories were subdivided into four additional groups (n = 6) based on the euthanasia timing (3 hours, 24 hours, 3 days and 7 days). The groups V and VLLL were inoculated with 100 µL of concentrated venom (40 µg/mL) in the gastrocnemius muscle. The muscle was irradiated using a gallium-aluminum-arsenide laser (GaAlAs) at 35 mW power and 4 J/cm² energy density for 3 hours, 24 hours, 3 days or 7 days after venom inoculation. To evaluate the myotoxic activity of the venom, CK activity was measured and the muscle was histologically analyzed. The low-level laser reduced venom-induced CK activity in the groups euthanized at 3 hours, 24 hours and 3 days (p < 0.0001). Histological analysis revealed that low-level laser reduced neutrophilic inflammation as well as myofibrillar edema, hemorrhage and myonecrosis following B. neuwiedi envenomation. These results suggest that low-level laser can be useful as an adjunct therapy following B. neuwiedi envenomation.