Oral sucrose might not provide effective analgesia in newborn infants

January 01, 0001

Oral sucrose might not provide effective analgesia in newborn infants

Many infants admitted to hospital undergo repeated invasive procedures. Oral sucrose is frequently given to relieve procedural pain in neonates on the basis of its effect on behavioural and physiological pain scores. The resaerchers from the UK assessed whether sucrose administration reduces pain-specific brain and spinal cord activity after an acute noxious procedure in newborn infants. In this double-blind, randomised controlled trial, 59 newborn infants at University College Hospital (London, UK) were randomly assigned to receive 0.5 mL 24% sucrose solution or 0.5 mL sterile water 2 min before undergoing a clinically required heel lance. 29 infants were assigned to receive sucrose and 30 to sterilised water; 20 and 24 infants, respectively, were included in the analysis of the primary outcome measure.

Nociceptive brain activity after the noxious heel lance did not differ significantly between infants who received sucrose and those who received sterile water (sucrose: mean 0.10; sterile water: mean 0.08). No significant difference was recorded between the sucrose and sterile water groups in the magnitude or latency of the spinal nociceptive reflex withdrawal recorded from the biceps femoris of the stimulated leg. The observational pain score (PIPP) was significantly lower in infants given sucrose than in those given sterile water (mean 5.8 vs 8.5) and significantly more infants had no change in facial expression after sucrose administration (35% vs 0%).

The researchers concluded: "Our data suggest that oral sucrose does not significantly affect activity in neonatal brain or spinal cord nociceptive circuits, and therefore might not be an effective analgesic drug. The ability of sucrose to reduce clinical observational scores after noxious events in newborn infants should not be interpreted as pain relief."

Sensible conclusion, but where to from here? What is a measure of pain in infants?

For the full abstract, click here.

The Lancet published online 1 September 2010
© 2010 Elsevier Limited
Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial. Rebeccah Slater, Laura Cornelissen, Lorenzo Fabrizi et al. Correspondence to Rebeccah Slater: r.slater@ucl.ac.uk

Category: N. Neurological. Keywords: oral, sucrose, analgesic, procedural, pain, newborn, infants, double blind randomised controlled trial, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 17 September 2010

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