Pain management strategies for thoracocentesis and thoracostomy in neonates: A systematic review and meta-analysis
Bibliographic record
Abstract
Objectives: Thoracostomy and thoracocentesis are painful invasive procedures. Several professional organizations have recommended the combined use of non-pharmacological and pharmacological interventions to alleviate pain from these procedures in neonates. However, none of these recommendations are based on a systematic review of the literature. The primary objective of this systematic review and meta-analysis was to synthesize the literature on pain management strategies for thoracotomy and thoracocentesis. Methods: Databases were searched for randomized trials evaluating pharmacological and non-pharmacological interventions for pain mitigation for thoracocentesis and thoracostomy in any age group from inception to March 2025. The literature search was updated in June 2025 and no additional eligible articles were identified for inclusion. Title and abstract screening, full-text screening, and data extraction were performed in duplicate. Risk of bias was assessed using Cochrane's risk of bias (RoB) tool version 2.0. The critically important outcome was pain measured using validated tools including unidimensional behaviours (comprising facial actions, body movements, and cry) tools and multidimensional (comprising combinations of contextual, behavioural, and/or physiological components) tools. Secondary outcomes included procedure success, procedure duration, ease of procedure, and adverse events. Pooled effect estimates were standardized mean difference and relative risk with 95% confidence intervals using random effects model. A GRADE assessment of the overall certainty of the evidence for each outcome was completed. Results: One study with 36 adult participants assessing pain from thoracocentesis was included. The interventions compared were topical vs subcutaneous administration of local anaesthetics. There was no difference in the overall procedural pain, patient satisfaction, and the number of attempts between the two groups. There was very low evidence of certainty for the critical outcome of pain. Conclusions: No recommendation for pain management for these procedures can be made from the single included study. Currently, professional guidelines recommend the use of subcutaneous lidocaine and intravenous opioids for thoracostomy. Future studies are recommended to evaluate the effectiveness of various pharmacological and non-pharmacological interventions (head-to-head comparison).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.033 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.018 | 0.041 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".