The Combined Use of Sucrose and Nonnutritive Sucking for Procedural Pain in Both Term and Preterm Neonates

Abstract

Many agents, both pharmacologic and nonpharmacologic, have been studied to alleviate neonatal pain, and the research is extensive. The 2 most commonly studied nonpharmacologic agents studied have been sucrose and nonnutritive sucking (NNS). There is increasing evidence that the synergistic effect of sucrose and NNS is more effective than the effect of sucrose or NNS alone. The purpose of this integrative review of the literature was to determine whether there is a relationship between the synergistic effect of combining sucrose and NNS administered before and during painful procedures, and reducing procedural pain in both preterm and term neonates. This integrative review indicates that the combination of sucrose and NNS is a safe, effective, and clinically significant means of providing procedural pain relief in neonates, both term and preterm.

Sedation in the Neonatal Intensive Care Unit: International Practice

“…This time interval is thought to coincide with the endogenous opioid release. When compared with local analgesia/EMLA or systemic acetaminophen (paracetamol) or morphine, glucose/ sucrose results in the most prominent decrease in pain scores [51][52][53][54][55][56]. More moderate positive results were obtained during immunization in infancy (2-6 months), resulting in the guidelines to use sweet solution with a pacifier (or other facility to maintain suctioning) only up to the age of 4, max 6 months [57].…”

“…It is believed that the effects of sucrose and nonnutritive sucking are mediated by both endogenous opioid and non-opioid systems. There is meta-analytical evidence in support of the use of oral administration of sucrose 24 %, glucose 30 %, or mother's milk in combination with a pacifier shortly before a painful procedure (e.g., blood sampling, nasogastric tube placement, immunization/vaccination) as an effective tool for procedural analgesia in neonates [51][52][53][54][55][56]. The observations on the use of sucrose during heel lancing hereby are much more common compared to other interventions or procedures.…”

Development of atraumatic heel-stick procedures by combined treatment with non-nutritive sucking, oral sucrose, and facilitated tucking: A randomised, controlled trial

“…NNS relieves preterm infants' pain by facilitating their sucking behaviour, which modulates nociception by orotactile stimulation of pathways that release endogenous nonopioids (Naughton, 2013). Similarly, providing FT during invasive procedures comforts preterm infants (Hill et al, 2005) and modulates mild pain (Liaw et al, 2012b;Axelin et al, 2006;Cignacco et al, 2012).…”

Dimensionamento dos procedimentos dolorosos e interveções para alívio da dor aguda em prematuros

“…Proporção maior foi encontrada por Carbajal et al (2008), onde a sacarose associada com sucção não nutritiva representou 4,7% dentre os procedimentos dolorosos que receberam algum tipo de tratamento para alívio da dor. O uso da sacarose combinada à sucção não nutritiva é mais eficaz e seguro do que o uso da sacarose e da sucção não nutritiva sozinhos em recém-nascidos pré-termo e a termo, devido a um efeito sinérgico, segundo o autor de uma revisão integrativa (NAUGHTON, 2013).…”