Pain management in the NICU, without drugs or sucrose

May 5, 2008

Sucrose and pharmacotherapy have long been the backbone of pain management in the neonatal intensive care unit. Two posters presented Sunday afternoon at PAS suggest that other methods may be equally effective in some settings.

Sucrose and pharmacotherapy have long been the backbone of pain management in the neonatal intensive care unit. Two posters presented Sunday afternoon at PAS suggest that other methods may be equally effective in some settings.

Researchers at Neomater Hospital e Maternidade, Sao Bernado do Campo in Brazil found that simple relaxation techniques significantly reduced pain scores in full-term neonates (poster 4454.4). Working with a group of 20 newborns, a psychomotor therapist used light skin touches for approximately five minutes to stimulate relaxation. After relaxation, each baby’s heel was lanced to collect blood for standard newborn screening tests. A matched control group of 20 newborns was given standard care before the same procedure.

Trained health care workers who were blinded to the intervention assessed pain in all 40 infants using the Neonatal Infant Pain Scale (NIPS). Observers recorded a NIPS score greater than 3, indicating pain, in 90% of the control group and 5% of the relaxation group.

Researchers at the University of Turku in Finland compared facilitated tucking by parents (FTP) with oral glucose, opioid (oxycodone) and placebo (water) in a prospective, randomized cross-over trial with 20 premature infants (poster 4454.7). Pain was measured using the Premature Infant Pain Profile (PIPP) during the first 30 seconds following heel lance or pharyngeal suctioning.

FTP provided the same degree of analgesia as oral sucrose during heel lancing. Both FTP and sucrose were more effective than opioid and placebo, which provided similar analgesia. None of the methods provided effective analgesia during pharyngeal suctioning.

Glucose had the highest rate of oxygen desaturation, bradycardia, or both, at 21.3%, followed by placebo at 12.5%. Oxycontin and FTP both had a 5% rate of desaturation, and no bradycardia.