Randomised trial of analgesic effects of sucrose, glucose, and pacifiers in term neonates

Abstract

Objectives To assess and compare the analgesic effects of orally administered glucose and sucrose and pacifiers. To determine the synergistic analgesic effect of sucrose and pacifiers. Design Randomised prospective study with validated behavioural acute pain rating scale. Setting Maternity ward. Participants 150 term newborns undergoing venepuncture randomly assigned to one of six treatment groups: no treatment; placebo (2 ml sterile water); 2 ml 30% glucose; 2 ml 30% sucrose; a pacifier; and 2 ml 30% sucrose followed by a pacifier. Results Median (interquartile) pain scores during venepuncture were 7 (5-10) for no treatment; 7 (6-10) for placebo (sterile water); 5 (3-7) for 30% glucose; 5 (2-8) for 30% sucrose; 2 (1-4) for pacifier; and 1 (1-2) for 30% sucrose plus pacifier. Mann-Whitney U test P values for comparisons of 30% glucose, 30% sucrose, pacifier, and 30% sucrose plus pacifier versus placebo (sterile water) were 0.005, 0.01, < 0.0001, and < 0.0001, respectively. Differences between group median pain scores for these comparisons were 2 (95% confidence interval 1 to 4), 2 (0 to 4), 5 (4 to 7), and 6 (5 to 8), respectively. P values for comparisons of 30% glucose, 30% sucrose, and 30% sucrose plus pacifier versus pacifier were 0.0001, 0.001, and 0.06, respectively. Differences between group medians for these comparisons were 3 (2 to 5), 3 (1 to 5), and 1 (0 to 2), respectively. Conclusion The analgesic effects of concentrated sucrose and glucose and pacifiers are clinically apparent in newborns, pacifiers being more effective than sweet solutions. The association of sucrose and pacifier showed a trend towards lower scores compared with pacifiers alone. These simple and safe interventions should be widely used for minor procedures in neonates.

Oral Sucrose and “Facilitated Tucking” for Repeated Pain Relief in Preterms: A Randomized Controlled Trial

“…[15][16][17] They promote self-regulation of the infant and provide oro-tactile, oro-gustatory, and tactile stimulation, capable of reducing infants' pain responses during most painful procedures. 15,[18][19][20][21] Sucrose is recommended extensively for pain relief in preterm infants [22][23][24] and has shown to be highly effective and safe for single procedures by Stevens et al 17 Sweet taste solutions seem to trigger endogenous opioid and nonopioid pathways. 25,26 FT is described as holding the infant by placing a hand on his or her hands and feet and by positioning the infant in a flexed midline position while in either a side-lying, supine, or prone position.…”

Prevention and Management of Pain in the Neonate: An Update

“…61 These measures have been shown to be useful in preterm and term neonates in reducing pain from a heel stick, 68,[70][71][72][73]79,80 venipuncture, 62,64,65,67,74,77,81 and subcutaneous injections 81 and are generally more effective when used in combination than when used alone. 63,65,68,69,80,82 Concentrated oral sucrose has been widely studied. Oral sucrose eliminates the electroencephalographic changes associated with a painful procedure 83 in a neonate, but the mechanism of pain relief by sucking oral sucrose is not known for certain.…”

“…These include use of oral sucrose/glucose, [62][63][64][65][66][67][68][69][70][71][72][73][74][75][76] breastfeeding, 77 nonnutritive sucking, 49,78 "kangaroo care" (skin-to-skin contact), 55,58 facilitated tuck (holding the arms and legs in a flexed position), 79 swaddling, 80 and developmental care, which includes limiting environmental stimuli, lateral positioning, the use of supportive bedding, and attention to behavioral clues. 61 These measures have been shown to be useful in preterm and term neonates in reducing pain from a heel stick, 68,[70][71][72][73]79,80 venipuncture, 62,64,65,67,74,77,81 and subcutaneous injections 81 and are generally more effective when used in combination than when used alone. 63,65,68,69,80,82 Concentrated oral sucrose has been widely studied.…”

Implementation and Case-Study Results of Potentially Better Practices to Improve Pain Management of Neonates

“…The majority (91%) of the centers selected Sweet-Ease (prepackaged 11-mL container of 24% sucrose solution; Children's Medical Ventures, Norwell, MA) as a convenient source of oral sucrose. Because of the added analgesic effect observed when infants suck on a pacifier during sucrose administration, 8,9 each center in the group administers sucrose in combination with oral stimulation (by oral syringe for precise administration followed by a pacifier for nonnutritive sucking or by pacifier dipped in solution). The appropriate population for sucrose analgesia still is being defined, and centers differ in the patients who are considered eligible for sucrose analgesia.…”