The Impact of Massage and Reading on Children’s Pain and Anxiety After Cardiovascular Surgery: A Pilot Study

Objectives: The purpose of this pilot study was three-fold: 1) to evaluate the safety and feasibility of instituting massage therapy in the immediate postoperative period after congenital heart surgery, 2) to examine the preliminary results on effects of massage therapy versus standard of care plus three reading visits on postoperative pain and anxiety, and 3) to evaluate preliminary effects of opioid and benzodiazepine exposure in patients receiving massage therapy compared with reading controls. Design: Prospective, randomized controlled trial. Setting: An academic children’s hospital. Subjects: Sixty pediatric heart surgery patients between ages 6 and 18 years. Interventions: Massage therapy and reading. Measurement and Main Results: There were no adverse events related to massage or reading interventions in either group. Our investigation found no statistically significant difference in Pain or State-Trait Anxiety scores in the initial 24 hours after heart surgery (T1) and within 48 hours of transfer to the acute care unit (T2) after controlling for age, gender, and Risk Adjustment for Congenital Heart Surgery 1 score. However, children receiving massage therapy had significantly lower State-Trait Anxiety scores after receiving massage therapy at time of discharge (T3; p = 0.0075) than children receiving standard of care plus three reading visits. We found no difference in total opioid exposure during the first 3 postoperative days between groups (median [interquartile range], 0.80 mg/kg morphine equivalents [0.29–10.60] vs 1.13 mg/kg morphine equivalents [0.72–6.14]). In contrast, children receiving massage therapy had significantly lower total benzodiazepine exposure in the immediate 3 days following heart surgery (median [interquartile range], 0.002 mg/kg lorazepam equivalents [0–0.03] vs 0.03 mg/kg lorazepam equivalents [0.02–0.09], p = 0.0253, Wilcoxon rank-sum) and number of benzodiazepine PRN doses (0.5 [0–2.5] PRN vs 2 PRNs (1–4); p = 0.00346, Wilcoxon rank-sum). Conclusions: Our pilot study demonstrated the safety and feasibility of implementing massage therapy in the immediate postoperative period in pediatric heart surgery patients. We found decreased State-Trait Anxiety scores at discharge and lower total exposure to benzodiazepines. Preventing postoperative complications such as delirium through nonpharmacologic interventions warrants further evaluation. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (https://ift.tt/2gIrZ5Y). Supported, in part, by the Stanford National Institutes of Health/National Center for Research Resources (NCRR) Clinical and Translational Science Award (CTSA) number UL1 RR025744 and by the Lucile Packard Foundation for Children’s Health. Dr. Staveski’s institution received funding from Cardiology 2015 (provided hotel room, registration, and travel fees), Children's Heart Association of Cincinnati, Center for Clinical and Translational Science and Training award, and an internal grant on delirium studies, and she received support for article research from the Stanford National Institutes of Health/NCRR CTSA award number UL1 RR025744 and by the Lucile Packard Foundation for Children’s Health. Dr. Boulanger’s institution received funding from Stanford. Dr. Erman and his institution received funding from Lucile Packard Children’s Hospital Stanford, and he disclosed work for hire as a paid contractor of Lucile Packard Children’s Hospital Stanford. Ms. Almgren received funding from NurseWeek (wrote Continuing Education Unit course in 2015, unrelated to submitted work). The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: Sandra.staveski@cchmc.org ©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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