Sucrose For Pain Relief
What is sucrose? Sucrose is sugar. In this case though, we are referring to a sucrose solution which is specially made up for newborn babies.
Purpose and intent:
To provide pain relief for infants undergoing minor procedures.
To prevent potential effects of pain experience on the developing newborn brain.
Use may include but not be limited to the following procedures:
-arterial, venous or capillary puncture
-heel pricks
-injections
-tape removal
-lumbar puncture
-suturing or suture removal
-urinary catheterization
-suprapubic tap
-painful occupational or physiotherapy
-dressing change
-eye exam using retractors
Guidelines:
Administered orally for relief of pain caused by minor procedures without a physician’s order to infants up to 12 months of age.
Use sucrose up to 8 doses in a 24 hours period. If a patient has more than 8 procedures in that time frame consider other methods of pain management.
For optimal effect give some sucrose directly onto the oral mucosa 2 minutes prior to the painful procedure, some immediately upon beginning and some half way through if the procedure lasts longer than 10 minutes. For babies who weight more than 1000 grams this can be partial doses.
Use a pacifier or skin to skin contact with a parent in conjunction with sucrose to enhance analgesic affect.
Options for products: Sucrose solution diluted from simple syrup to 24% is kept for one week in a refrigerator, and when taken to the bedside is used within 4 hours. Commercial prepared sucrose solution kept at room temperature according to the date on the package. When opened is kept at the bedside in a protective package for up to 12 hours.
Assess the analgesic effectiveness of the sucrose and need for subsequent administrations during and following the procedure.
For any infant who demonstrates unexplained nausea, vomiting, abdominal pain and hypoglycemia after exposure to sucrose consult the Metabolic service to investigate the possibility of the infant having Hereditary Fructose Intolerance, a rare enzyme deficiency disorder.
References:
Biran, V., Gourrier, E., Cimerman, P., Walter-Nicolet, E., Mitanchez, D., & Carbajal, R. (2011). Analgesic Effects of EMLA Cream and Oral Sucrose. During Venipuncture in Preterm Infants Pediatrics, 128(1), e63-e70.
Dilli D, Küçük IG, Dallar Y. Interventions to reduce pain during vaccination in infancy. (2009). Journal of Pediatrics. 2009 Mar;154(3):385-90.
Harrison, D.M., Daley, A.J., Rautenbacher, K., Loughnan, P.M., Manias E. & Johnston L.J. (2007). Bacterial contamination of oral sucrose solutions. Archives of Disease in Childhood. Fetal and Neonatal Edition.92;155-
Harrison, D., Yamada, J., Adams-Webber, T., Ohlson, A., Beyene, J. & Stevens, B. (2011) Sweet tasting solutions for reduction of needle-related procedural pain in children aged one to 16 years. . Cochrane Database of Systematic Reviews, Issue 10.
Kristoffersen, L., Skogvoll, E. & Hafström, M. (2011). Pain Reduction on Insertion of a Feeding Tube in Preterm Infants: A Randomized Controlled Trial. Pediatrics, 127(6), e1446-e1454.
McCullough, S., Halton, T., Mowbray, D. & Macfarlane, P.I. (2008) Lingual sucrose reduces the pain response to nasogastric tube insertion: a randomized clinical trial. Archives of Disease in Children Fetal and Neonatal Edition. 93(2) F100-103.
O’Sullivan,A., O’Connor,M., Brosnahan, D., McCreery, K. & Dempsey, E.M. (2010). Sweeten, soother and swaddle for retinopathy of prematurity screening: a randomised placebo controlled trial. Archives of Disease in Childhood Fetal Neonatal Edition. 95(6).F419–F422.
Stevens, B., Yamada, J., Lee, G.Y & Ohlsson, A. (2013) Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database of Systematic Reviews, Issue 1.
Taddio, A., Shah V. & Katz J. (2009).Reduced Infant Response to a Routine Care Procedure After Sucrose Analgesia. Pediatrics. 123 (3) ;e425.
Taddio, A., Shah, V., Stephens, D., Parvez, E., Hogan, M., Kikuta, A., Koren, G. & Katz, J. (2011). Effect of Liposomal Lidocaine and Sucrose Alone and in Combination for Venipuncture Pain in Newborns. Pediatrics, 127(4), e940-e947.
Thyr, M , Sundholm, A., Teeland, L. & Rahm, V (2007 ) Oral glucose as an analgesic to reduce infant distress following immunization at the age of 3, 5 and 12 months. Acta Pædiatrica, 96, p 233–236
