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Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial

Summary Background 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. We assessed whether sucrose administration reduces pain-specific... Full description

Journal Title: Lancet 2010, Vol.376 (9748), p.1225-1232
Main Author: Slater, Rebeccah, Dr
Other Authors: Cornelissen, Laura, MSci , Fabrizi, Lorenzo, PhD , Patten, Debbie, BSc , Yoxen, Jan, BSc , Worley, Alan, MSc , Boyd, Stewart, MD , Meek, Judith, MBBS , Fitzgerald, Maria, Prof
Format: Electronic Article Electronic Article
Language: English
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Quelle: Alma/SFX Local Collection
Publisher: Kidlington: Elsevier Ltd
ID: ISSN: 0140-6736
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title: Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial
format: Article
creator:
  • Slater, Rebeccah, Dr
  • Cornelissen, Laura, MSci
  • Fabrizi, Lorenzo, PhD
  • Patten, Debbie, BSc
  • Yoxen, Jan, BSc
  • Worley, Alan, MSc
  • Boyd, Stewart, MD
  • Meek, Judith, MBBS
  • Fitzgerald, Maria, Prof
subjects:
  • Abridged Index Medicus
  • Administration, Oral
  • Analgesia
  • Analgesics
  • Babies
  • Biological and medical sciences
  • Biomedical research
  • Blood Specimen Collection
  • Brain
  • Brain - physiology
  • Care and treatment
  • Clinical medicine
  • Clinical trials
  • Data collection
  • Dosage and administration
  • Double-Blind Method
  • Drugs
  • Electroencephalography
  • Electromyography
  • Evoked Potentials
  • Facial Expression
  • Fast track
  • Fast track — Articles
  • Female
  • General aspects
  • Health aspects
  • Heart Rate
  • Hospitals
  • Humans
  • Infant Behavior
  • Infant, Newborn
  • Infants
  • Infants (Newborn)
  • Internal Medicine
  • Male
  • Medical sciences
  • Methods
  • Neonates
  • Newborn babies
  • Oxygen - blood
  • Pain
  • Pain Measurement
  • Spinal cord
  • Spine - physiology
  • Studies
  • Sucrose
  • Sucrose - administration & dosage
  • Water - administration & dosage
ispartof: Lancet, 2010, Vol.376 (9748), p.1225-1232
description: Summary Background 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. We assessed whether sucrose administration reduces pain-specific brain and spinal cord activity after an acute noxious procedure in newborn infants. Methods 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. Randomisation was by a computer-generated randomisation code, and researchers, clinicians, participants, and parents were masked to the identity of the solutions. The primary outcome was pain-specific brain activity evoked by one time-locked heel lance, recorded with electroencephalography and identified by principal component analysis. Secondary measures were baseline behavioural and physiological measures, observational pain scores (PIPP), and spinal nociceptive reflex withdrawal activity. Data were analysed per protocol. This study is registered, number ISRCTN78390996. Findings 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, 95% CI 0·04–0·16; sterile water: mean 0·08, 0·04–0·12; p=0·46). 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 PIPP score was significantly lower in infants given sucrose than in those given sterile water (mean 5·8, 95% CI 3·7–7·8 vs 8·5, 7·3–9·8; p=0·02) and significantly more infants had no change in facial expression after sucrose administration (seven of 20 [35%] vs none of 24; p
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0140-6736
fulltext: fulltext
issn:
  • 0140-6736
  • 1474-547X
url: Link


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titleOral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial
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creatorSlater, Rebeccah, Dr ; Cornelissen, Laura, MSci ; Fabrizi, Lorenzo, PhD ; Patten, Debbie, BSc ; Yoxen, Jan, BSc ; Worley, Alan, MSc ; Boyd, Stewart, MD ; Meek, Judith, MBBS ; Fitzgerald, Maria, Prof
creatorcontribSlater, Rebeccah, Dr ; Cornelissen, Laura, MSci ; Fabrizi, Lorenzo, PhD ; Patten, Debbie, BSc ; Yoxen, Jan, BSc ; Worley, Alan, MSc ; Boyd, Stewart, MD ; Meek, Judith, MBBS ; Fitzgerald, Maria, Prof
descriptionSummary Background 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. We assessed whether sucrose administration reduces pain-specific brain and spinal cord activity after an acute noxious procedure in newborn infants. Methods 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. Randomisation was by a computer-generated randomisation code, and researchers, clinicians, participants, and parents were masked to the identity of the solutions. The primary outcome was pain-specific brain activity evoked by one time-locked heel lance, recorded with electroencephalography and identified by principal component analysis. Secondary measures were baseline behavioural and physiological measures, observational pain scores (PIPP), and spinal nociceptive reflex withdrawal activity. Data were analysed per protocol. This study is registered, number ISRCTN78390996. Findings 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, 95% CI 0·04–0·16; sterile water: mean 0·08, 0·04–0·12; p=0·46). 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 PIPP score was significantly lower in infants given sucrose than in those given sterile water (mean 5·8, 95% CI 3·7–7·8 vs 8·5, 7·3–9·8; p=0·02) and significantly more infants had no change in facial expression after sucrose administration (seven of 20 [35%] vs none of 24; p<0·0001). Interpretation 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. Funding Medical Research Council.
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2DOI: 10.1016/S0140-6736(10)61303-7
3PMID: 20817247
4CODEN: LANCAO
languageeng
publisherKidlington: Elsevier Ltd
subjectAbridged Index Medicus ; Administration, Oral ; Analgesia ; Analgesics ; Babies ; Biological and medical sciences ; Biomedical research ; Blood Specimen Collection ; Brain ; Brain - physiology ; Care and treatment ; Clinical medicine ; Clinical trials ; Data collection ; Dosage and administration ; Double-Blind Method ; Drugs ; Electroencephalography ; Electromyography ; Evoked Potentials ; Facial Expression ; Fast track ; Fast track — Articles ; Female ; General aspects ; Health aspects ; Heart Rate ; Hospitals ; Humans ; Infant Behavior ; Infant, Newborn ; Infants ; Infants (Newborn) ; Internal Medicine ; Male ; Medical sciences ; Methods ; Neonates ; Newborn babies ; Oxygen - blood ; Pain ; Pain Measurement ; Spinal cord ; Spine - physiology ; Studies ; Sucrose ; Sucrose - administration & dosage ; Water - administration & dosage
ispartofLancet, 2010, Vol.376 (9748), p.1225-1232
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5Worley, Alan, MSc
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descriptionSummary Background 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. We assessed whether sucrose administration reduces pain-specific brain and spinal cord activity after an acute noxious procedure in newborn infants. Methods 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. Randomisation was by a computer-generated randomisation code, and researchers, clinicians, participants, and parents were masked to the identity of the solutions. The primary outcome was pain-specific brain activity evoked by one time-locked heel lance, recorded with electroencephalography and identified by principal component analysis. Secondary measures were baseline behavioural and physiological measures, observational pain scores (PIPP), and spinal nociceptive reflex withdrawal activity. Data were analysed per protocol. This study is registered, number ISRCTN78390996. Findings 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, 95% CI 0·04–0·16; sterile water: mean 0·08, 0·04–0·12; p=0·46). 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 PIPP score was significantly lower in infants given sucrose than in those given sterile water (mean 5·8, 95% CI 3·7–7·8 vs 8·5, 7·3–9·8; p=0·02) and significantly more infants had no change in facial expression after sucrose administration (seven of 20 [35%] vs none of 24; p<0·0001). Interpretation 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. Funding Medical Research Council.
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1Administration, Oral
2Analgesia
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4Babies
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16Drugs
17Electroencephalography
18Electromyography
19Evoked Potentials
20Facial Expression
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24General aspects
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27Hospitals
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29Infant Behavior
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31Infants
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33Internal Medicine
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39Oxygen - blood
40Pain
41Pain Measurement
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titleOral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial
authorSlater, Rebeccah, Dr ; Cornelissen, Laura, MSci ; Fabrizi, Lorenzo, PhD ; Patten, Debbie, BSc ; Yoxen, Jan, BSc ; Worley, Alan, MSc ; Boyd, Stewart, MD ; Meek, Judith, MBBS ; Fitzgerald, Maria, Prof
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abstractSummary Background 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. We assessed whether sucrose administration reduces pain-specific brain and spinal cord activity after an acute noxious procedure in newborn infants. Methods 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. Randomisation was by a computer-generated randomisation code, and researchers, clinicians, participants, and parents were masked to the identity of the solutions. The primary outcome was pain-specific brain activity evoked by one time-locked heel lance, recorded with electroencephalography and identified by principal component analysis. Secondary measures were baseline behavioural and physiological measures, observational pain scores (PIPP), and spinal nociceptive reflex withdrawal activity. Data were analysed per protocol. This study is registered, number ISRCTN78390996. Findings 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, 95% CI 0·04–0·16; sterile water: mean 0·08, 0·04–0·12; p=0·46). 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 PIPP score was significantly lower in infants given sucrose than in those given sterile water (mean 5·8, 95% CI 3·7–7·8 vs 8·5, 7·3–9·8; p=0·02) and significantly more infants had no change in facial expression after sucrose administration (seven of 20 [35%] vs none of 24; p<0·0001). Interpretation 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. Funding Medical Research Council.
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