Article type
Year
Abstract
Background: Management of pain in the neonatal intensive care unit (NICU) is less than optimal[1]. Strategies to manage pain from surgery, illness and major procedures exist but the means to prevent or reduce pain from investigational procedures such as heel lances and venepunctures are largely lacking[2]. The challenge of providing simple, safe and effective pain-relieving interventions for newborns remains an obstacle to evidence-based practice.
Objectives: To determine the efficacy, effect of dose and safety of sucrose for relieving pain in newborns as assessed by validated individual pain indicators and composite pain scores.
Methods: A systematic review was completed on all randomized controlled trials (RCTs) of infants who received sucrose for treatment of procedural pain from heel lances or venepunctures. This review is a recent update of the systematic review completed in 2001. We searched from 1966 to January 2004 in MEDLINE, and from 1980 to 2004, in EMBASE, the Cochrane Database of Systematic Reviews 1st Quarter 2004 and the Cochrane Central Register of Controlled Trials 1st Quarter 2004. Medical subject headings (MeSH) included infant, newborn, pain, analgesia, and sucrose. We also searched reference lists of relevant articles. Methodologic quality measures included blinding of randomization, intervention, outcome measurement and completeness of follow up. Data were extracted and independently rated by 3 reviewers. A meta-analysis was performed on 3 studies using a weighted mean difference for continuous data with 95% confidence intervals.
Results: In this update, 6 new RCTs were identified. From these 6 studies, 2 were excluded as infants did not meet the inclusion criteria in one study and another study was a duplicate publication. Twenty-one trials (1,616 infants) met the inclusion criteria. Comprehensive meta-analysis-analytic techniques could not be used across all studies because of the inconsistency in the outcome measures used to assess pain and the differences in the statistical reporting of results. Sucrose generally was found to decrease individual physiologic (e.g. heart rate) and behavioral (e.g. the mean percent time crying, and facial action) pain indicators and composite pain scores in neonates in NICUs undergoing heel lances or venepunctures.When Premature Infant Pain Profile (PIPP) scores were pooled across three studies, scores were significantly reduced in infants who were given sucrose (dose range 0.012 g to 0.12 g) compared to the control group, WMD -1.64 (95% CI -2.47,- 0.81); p = 0.0001 at 30 seconds and WMD -2.05, (95% CI -3.08, -1.02); p = 0.00010 at 60 seconds after heel lance.
Conclusions: We recommend the use of 0.012 - 0.12 g of sucrose (e.g. 0.05 0.50 ml of 24% sucrose) administered approximately 2 minutes before single heel lances and venepunctures for pain relief in neonates.
References 1. American Academy of Pediatrics Committee on Fetus and Newborn Committee on Drugs Section on Anesthesiology. Section on Surgery Canadian Paediatric Society Fetus and Newborn Committee. Prevention and management of pain and stress in the neonate. Pediatrics. 2000;105(2):454-61. 2. Anand KJ. Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med. 2001;155(2):173-80.
Objectives: To determine the efficacy, effect of dose and safety of sucrose for relieving pain in newborns as assessed by validated individual pain indicators and composite pain scores.
Methods: A systematic review was completed on all randomized controlled trials (RCTs) of infants who received sucrose for treatment of procedural pain from heel lances or venepunctures. This review is a recent update of the systematic review completed in 2001. We searched from 1966 to January 2004 in MEDLINE, and from 1980 to 2004, in EMBASE, the Cochrane Database of Systematic Reviews 1st Quarter 2004 and the Cochrane Central Register of Controlled Trials 1st Quarter 2004. Medical subject headings (MeSH) included infant, newborn, pain, analgesia, and sucrose. We also searched reference lists of relevant articles. Methodologic quality measures included blinding of randomization, intervention, outcome measurement and completeness of follow up. Data were extracted and independently rated by 3 reviewers. A meta-analysis was performed on 3 studies using a weighted mean difference for continuous data with 95% confidence intervals.
Results: In this update, 6 new RCTs were identified. From these 6 studies, 2 were excluded as infants did not meet the inclusion criteria in one study and another study was a duplicate publication. Twenty-one trials (1,616 infants) met the inclusion criteria. Comprehensive meta-analysis-analytic techniques could not be used across all studies because of the inconsistency in the outcome measures used to assess pain and the differences in the statistical reporting of results. Sucrose generally was found to decrease individual physiologic (e.g. heart rate) and behavioral (e.g. the mean percent time crying, and facial action) pain indicators and composite pain scores in neonates in NICUs undergoing heel lances or venepunctures.When Premature Infant Pain Profile (PIPP) scores were pooled across three studies, scores were significantly reduced in infants who were given sucrose (dose range 0.012 g to 0.12 g) compared to the control group, WMD -1.64 (95% CI -2.47,- 0.81); p = 0.0001 at 30 seconds and WMD -2.05, (95% CI -3.08, -1.02); p = 0.00010 at 60 seconds after heel lance.
Conclusions: We recommend the use of 0.012 - 0.12 g of sucrose (e.g. 0.05 0.50 ml of 24% sucrose) administered approximately 2 minutes before single heel lances and venepunctures for pain relief in neonates.
References 1. American Academy of Pediatrics Committee on Fetus and Newborn Committee on Drugs Section on Anesthesiology. Section on Surgery Canadian Paediatric Society Fetus and Newborn Committee. Prevention and management of pain and stress in the neonate. Pediatrics. 2000;105(2):454-61. 2. Anand KJ. Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med. 2001;155(2):173-80.