Does Sucrose Analgesia Promote Physiologic Stability in Preterm Neonates?

Abstract

A double-blind, randomized controlled trial was conducted with infants born <31 weeks of gestational age and recruited within 48 h of life. The infants were randomized to receive up to three doses of 0.1 ml of either 24% sucrose or sterile water (placebo) for every painful procedure during the 1st week of life. The purpose of this study was to test the efficacy of treating all procedural pain with sucrose on overall physiological stability. The hypotheses were that infants who received 24% sucrose for all painful procedures would be less stressed as measured by salivary cortisol, and more physiologically stable as measured by pulse rate variability than those who received placebo. Salivary cortisol was measured before and 30 min after a painful procedure, whereas the pulse rate was continuously recorded, from second to second, from a pulse oximeter. There were no group differences in the cortisol response to a painful stimulus or in pulse rate variability over time. There was, however, a significant correlation between standard deviation of pulse rate and number of doses of sucrose only in the group who received high doses of sucrose.

Initial validation of the Behavioral Indicators of Infant Pain (BIIP)

“…Similarly, although sucrose reduces pain behavior, varying effects on different physiologic indices have been found (e.g. Boyer et al, 2004; reviewed by Stevens et al, 2004).…”

“…Similarly, although sucrose reduces pain behavior, varying effects on different physiologic indices have been found (e.g. Boyer et al, 2004; reviewed by Stevens et al, 2004).In a recent review of pain scales available for use in infants, none of the existing tools appear to be ideal for all situations and many have had limited psychometric testing (Duhn and Medves, 2004). Of the unidimensional scales, the Neonatal Facial Coding System is the most (Grunau and Craig, 1987).…”

A eficácia da sacarose no alívio de dor em neonatos: revisão sistemática da literatura

“…Sixteen of the 29 articles selected were studies of fullterm neonate patient samples, [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] eleven studied preterm neonates [33][34][35][36][37][38][39][40][41][42][43] and two included comparisons between preterm and fullterm neonates. 44,45 The volume of sucrose used in the majority of the studies involving fullterm neonates was 2 ml, [17][18][19][20][21][22][23][24][25][27][28][29][30][31][32] with concentrations of 12%, 20,24,30,31 12.5%, 18,32 24%, …”

“…37,40,43 The concentrations administered were 15%, 40 24%, 37 25% 38,42 and 50% 33 in single-dose studies, and 24% 39,41,43 in studies of repeat doses. Two studies 34,40 assessed the sucrose solution at varying volumes and concentrations.…”

“…Just three studies, 39,41,43 performed on preterm neonates, administrated sucrose solution in repeat doses and more than once during the same painful procedure 39 or during all painful procedures undergone by the neonate over a seven-day period, during their stay at the Neonatal-ICU. 41,43 In just one study 43 the solution was administered to a location other than the anterior region of the neonates tongue, in order to avoid possible aspiration.…”