BMJ 1999;319:1393-1397 ( 27 November )

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Randomised trial of analgesic effects of sucrose, glucose, and pacifiers in term neonates

Editorial by Choonara

R Carbajal, paediatrician, ^a X Chauvet, general practitioner, ^a S Couderc, paediatrician, ^b M Olivier-Martin, paediatrician. ^a

^a Department of Paediatrics, Poissy Hospital, 78300 Poissy, France, ^b Maternity Ward, Poissy Hospital

Correspondence to: R Carbajal carbajal{at}club-internet.fr

Objectives: To assess and compare the analgesic effects of orally administered glucose and sucrose and pacifiers. To determine the synergistic analgesic effect of sucrose and pacifiers.
Design: Randomised prospective study with validated behavioural acute pain rating scale.
Setting: Maternity ward.
Participants: 150 term newborns undergoing venepuncture randomly assigned to one of six treatment groups: no treatment; placebo (2 ml sterile water); 2 ml 30% glucose; 2 ml 30% sucrose; a pacifier; and 2 ml 30% sucrose followed by a pacifier.
Results: Median (interquartile) pain scores during venepuncture were 7 (5-10) for no treatment; 7 (6-10) for placebo (sterile water); 5 (3-7) for 30% glucose; 5 (2-8) for 30% sucrose; 2 (1-4) for pacifier; and 1 (1-2) for 30% sucrose plus pacifier. Mann-Whitney U test P values for comparisons of 30% glucose, 30% sucrose, pacifier, and 30% sucrose plus pacifier versus placebo (sterile water) were 0.005, 0.01, <0.0001, and <0.0001, respectively. Differences between group median pain scores for these comparisons were 2 (95% confidence interval 1 to 4), 2 (0 to 4), 5 (4 to 7), and 6 (5 to 8), respectively. P values for comparisons of 30% glucose, 30% sucrose, and 30% sucrose plus pacifier versus pacifier were 0.0001, 0.001, and 0.06, respectively. Differences between group medians for these comparisons were 3 (2 to 5), 3 (1 to 5), and 1 (0 to 2), respectively.
Conclusion: The analgesic effects of concentrated sucrose and glucose and pacifiers are clinically apparent in newborns, pacifiers being more effective than sweet solutions. The association of sucrose and pacifier showed a trend towards lower scores compared with pacifiers alone. These simple and safe interventions should be widely used for minor procedures in neonates.

Key messages The analgesic effects on newborn infants of sucrose, glucose, and pacifiers can be clearly detected by a behavioural pain rating scale Pacifiers had a better analgesic effect than sweet solutions A synergistic effect was found with a combination of sucrose and pacifiers Sweet solutions and pacifiers constitute simple and safe interventions that can be used to provide analgesia in newborns during minor procedures

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