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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Poincaré plot indices as a marker for acute pain response in newborns


Traditional views on neonatal pain neglected long neglected the neonates’ capability of feeling pain. Newborn infants experience at least one painful procedure during their first days of life, but with a lower gestational age, invasive procedures become more frequent and invasive. The modulation of the autonomic nervous system (ANS) is significantly changed during painful procedures. The analysis of the heart rate variability is shown to be a reliable tool in analyzing the ANS. In this study, the dynamic of the system has been examined by applying the Poincaré plot analysis, a primer of nonlinear methods used in the analysis of the ANS. The aim of this study is to assess the occurrence of changes in linear heart rate variability parameters, to determine the changes in the Poincaré plot indices and to evaluate the correlation between their differences in healthy newborns. The results have shown a significant increase in the heart rate, a reduction of the duration of RR intervals, and the square root of the mean squared differences between successive RR intervals (RMSSD), as well as a decrease in the short-term variability (SD1) of the Poincare plot. The results highlight the need for studying the application of nonlinear analyses of the HRV on the effects of pain on the ANS and its long-term effects on the infant.

Key words: autonomic nervous system, pain, poincare plot, nonlinear analysis, heart rate variability

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Diclofenac premedication, as the effect of preventive anelgesia after post thoracotomy/thoracoscopy pain, as well as the changes of the lung function test values


Preventive analgesia is defined as administration of analgetics or nerve blockade before the surgical procedure. As a result of the preventive antinociceptive treatment, the quantity of post-operative medications can be decreased, the analgesia has less complications and the patients are more satisfied [1,2].

In our study we intend to examine the preventive analgetic effect a single oral dose of diclofenac.

The hypothesis of the study is that preventive analgesia by single dose of diclofenac results in 25% decrease of the postoperative VAS scores as compared to the control group.

Key words: preventive, pain, analgesia

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