Explanation: Oral Sucrose and Neonatal Pain

Thompson D.G. (2005) Utilizing an oral sucrose solution to minimize neonatal pain. Journal of Specialized Pediatric Nursing. Jan-Mar.10 (1):3-10.

The administration of sucrose or the combination of sucrose with non-nutritive sucking is one of the most frequently studied nonpharmacologic interventions for the relief of procedural pain in neonates (Stevens, 1999). Research demonstrates that sucrose can safely and effectively provide analgesia for young infants receiving heel lancings and other painful procedures. It is thought that the analgesic effect of sucrose works on opioid receptors because in animal studies, this effect can be blocked by naloxone (Blass, Fitzgerald, & Kehoe, 1987). The age dependency of oral sucrose analgesia may be the result of developmental changes in the interaction between gustatory and pain pathways (Anseloni et al., 2002). The unique response of the neonate to an oral sucrose solution allows for a very safe and effective measure in minimizing procedural pain. (from pages 3-4)

D’Apolito K C. (2006) State of the science: procedural pain management in the neonate. Journal of Perinatal- Neonatal Nursing. Jan-Mar. 20 (1). 56-61.

NONPHARMACOLOGIC TREATMENT OF PROCEDURAL PAIN

Nonpharmacologic treatments used to decrease neonatal procedural pain include oral sucrose, skin-to-skin contact, and breast-feeding. Most evidence has been reported regarding the benefit of administering oral sucrose 2 minutes before a painful procedure. Data are just becoming available regarding the efficacy of skin-to-skin contact or breast-feeding.

Oral sucrose The calming effect of sucrose occurs through the release of endogenous opiates triggered by the sweet taste through taste receptors located at the tip of the tongue.55,56 Several studies have reported that 24% sucrose with nonnutritive sucking seems to be effective for reducing heel stick pain.40–42 Results were similar whether the neonate received 2 mL or 0.5 mL of sucrose solution.41,42 Sucrose solution has also been used to treat the pain associated with an eye examination for retinopathy of prematurity (classified as severe, Table 2). No significant differences in pain scores, heart rate, respiratory rate, or oxygen saturation were found when the administration of a 24% sucrose solution was compared to the administration of sterile water prior to this procedure.42 (from page 58)

Benis, M. (2002) Efficacy of sucrose as analgesia for procedural pain in neonates. Advances in Neonatal Care. Apr. 2(2). 93-100.

Analgesics may be employed for major procedures and postoperative pain, although use of analgesics for minor procedures is less frequent because of concerns about adverse effects or toxicity. Various nonpharmocologic methods have been used to decrease pain in infants, including nonnutritive sucking, containment, positioning, and vestibular activity. The most extensively studied intervention to decrease pain during procedures in infants is the administration of oral sucrose.

Sucrose administered orally before painful procedures has shown a decrease in the following:

 Duration of crying  Facial action associated with pain  Heart rate  Composite pain scores

The pain relief elicited by sucrose solutions is thought to be biphasic, with an immediate reabsorptive calming effect, followed by the activation of endogenous opioids. This second mechanism, involving the release of endorphins that decrease pain in infants, is supported by animal studies that have shown that the analgesic effects of sucrose can be blocked by administering an opioid antagonist. In addition, Blass and Ciaramitaro showed that infants born to methadone-dependent mothers were unresponsive to the analgesic properties of sucrose. (from page 94)

Shared by all, therefore CENTRAL Shared by two, should be considered Shared by two, but requires careful thinking and may or may not need to be included Shared by two, but unnecessary to discussion