Sucrose for Procedural Pain Management in Infants

Abstract

The use of oral sucrose has been the most extensively studied pain intervention in newborn care to date. More than 150 published studies relating to sweet-taste-induced calming and analgesia in human infants have been identified, of which 100 (65%) include sucrose. With only a few exceptions, sucrose, glucose, or other sweet solutions reduced pain responses during commonly performed painful procedures in diverse populations of infants up to 12 months of age. Sucrose has been widely recommended for routine use during painful procedures in newborn and young infants, yet these recommendations have not been translated into consistent use in clinical practice. One reason may be related to important knowledge and research gaps concerning analgesic effects of sucrose. Notably, the mechanism of sweet-taste-induced analgesia is still not precisely understood, which has implications for using research evidence in practice. The aim of this article is to review what is known about the mechanisms of sucrose-induced analgesia; highlight existing evidence, knowledge gaps, and current controversies; and provide directions for future research and practice. Pediatrics 2012;130:918-925

Prevention and Management of Procedural Pain in the Neonate: An Update

“…It has been extensively studied for this purpose, yet many gaps in knowledge remain, including appropriate dosing, mechanism of action, soothing versus analgesic effects, and long-term consequences. [71][72][73] A meta-analysis of 57 studies including >4730 infants with gestational ages ranging from 25 to 44 weeks concluded that sucrose is safe and effective for reducing procedural pain from a single event. 74 Maximum reductions in physiologic and behavioral pain indicators have been noted when sucrose was administered ∼2 minutes before a painful stimulus, and the effects lasted ∼4 minutes.…”

“…82 Although an optimal dose has not been determined, 74 an oral dose of 0.1 to 1 mL of 24% sucrose (or 0.2-0.5 mL/kg) 2 minutes before a painful procedure has been recommended, taking into account gestational age, severity of illness, and procedure to be performed. 71 The role and safety of long-term sucrose use for persistent, ongoing pain have not been systematically studied. One study in 107 preterm infants of <31 weeks' gestation found worse neurodevelopmental scores at 32, 36, and 40 weeks' gestational age in infants who had received >10 doses of sucrose over a 24-hour period in the first week of life, raising concerns about frequent dosing in newly born preterm infants.…”

“…More research is needed to better understand the effects of sucrose use for analgesia. 71,81,84 Glucose has also been found to be effective in decreasing response to brief painful procedures. A meta-analysis of 38 RCTs that included 3785 preterm and term neonates found that the administration of 20% to 30% glucose solutions reduced pain scores and decreased crying during heel lance and venipuncture compared with water or no intervention.…”

Reported practice variation in pediatric pain management: a survey of Canadian pediatric emergency physicians

“…[18][19][20] The medical literature has long demonstrated many effective pharmacologic and nonpharmacologic interventions (NPIs) for pediatric pain. 15,[21][22][23][24][25] The frequency and success of application of these interventions by Canadian pediatric emergency physicians has not been reported. The purpose of this study was to describe reported practice patterns for pediatric emergency medicine (PEM) physicians and to explore factors that facilitate or hinder pain management.…”

Sucrose and Warmth for Analgesia in Healthy Newborns: An RCT

“…1 The short-term effects of painful procedures include crying or grimacing, disturbance in sleep or wakefulness state, increased oxygen consumption, ventilation-perfusion mismatch, and increased gastric acidity. [2][3][4] The long-term effects may be an exaggerated response to pain in later infancy 5 and the neurotoxicity of untreated pain in the developing brain. 6 Strong pharmacologic interventions are rarely used during short, minor painful procedures in neonates because of the risk of adverse effects on the newborn's respiratory and central nervous systems.…”