Introduction: This systematic literature review aims to investigate and delineate the appropriate use of non-pharmacological treatments in pain management in paediatric cardiac surgery.Choosing to act earlier with non-pharmacological techniques may help to prevent side effects often associated with the use of drugs. It is acknowledged that neuro-cognitive pathways directed at pain may be disrupted if attention is shifted to another focus. This investigation aims to search the literature for non-pharmacological techniques and strategies that the nurse can implement independently in pain management.

Methods: The systematic literature review was conducted between February and March 2021 on 4 databases: Pubmed, Cinahl, Cochrane, and Web of Science through 10 search strings, adding 10 grey literature articles from editorials, journals, and textbooks. The search yielded 2739 records, of which only 62 were deemed elective for the qualitative assessment using the AMSTAR II tools for systematic reviews, STROBE for observational studies, and the "Joanna Briggs Institute Checklist" for publishing. A total of 54 articles were included in the review.

Results: Non-pharmacological techniques have produced several outcomes, all positively affecting pain and anxiety control in paediatric cardiac surgery. Among the non-pharmacological treatments, the presence of one or more parents is of fundamental importance for paediatric patients to help them manage both post-operative and procedural pain. Different approaches can be used: distraction techniques and tools include breathing, images, music, electronic devices, or hypnosis, progressive muscle relaxation, skin stimulation methods (cold, heat, vibration, pressure), touch (massage), nutritive sucking with sweet solutions (glucose in infants) and non-nutritive sucking with an oral stimulant (dummy). Music therapy is an excellent non-pharmacological technique for stress and pain control.

Conclusions: The non-pharmacological approach to pain management offers many advantages in caring for the paediatric post-cardiac patient. Firstly, it can reduce the dosages of painkillers or exclude the use of pharmacological treatments altogether. Secondly, non-pharmacological techniques have produced several results, which can be carried out independently by the nurse, all of which positively affect pain and anxiety control in the healthcare setting. Most non-pharmacological treatments are cheap, easily accessible, safe to use, and non-invasive; they should always be the first choice for post-cardiac pain management.

References

Benini, F., & Trapanotto, M., (2010). La valutazione del dolore nel bambino. IdB - Giornale Italiano di Scienze Infermieristiche Pediatriche, 2, 45-48.

Pancekauskaitė, G., & Jankauskaitė, L. (2018). Paediatric pain medicine: pain differences, recognition and coping acute procedural pain in paediatric emergency room. Medicina, 54(6), 94.