Comparison of Minimal Effective Dose of Sucrose for Pain Relief in Neonates After Minor Procedures

Abstract

: Sucrose solution has been demonstrated to reduce pain in neonates following minor procedures, thereby enhancing their comfort and facilitating recovery. Despite its proven benefits, there is a lack of detailed information regarding the minimal dose of sucrose necessary for effective pain relief. Accurate identification of this minimal effective dose is crucial for optimizing pain management. The aim of this study was to establish a minimal effective dose of 24% sucrose for pain relief in neonates after minor procedures.

Objective: To compare the outcome of 0.2 ml versus 0.5 ml sucrose solution for pain relief in neonates after minor procedures

Study design: Randomized, single-blinded controlled trial

Study place and duration: Department of Pediatric Surgery, x y z Hospital, from March 2023 to February 2024.

Patients and methods: A total of 148 neonates admitted to the NICU for preoperative management were enrolled in this study. Group I (74 neonates) underwent intravenous cannulation and received 0.2 ml of sucrose solution, while Group II (74 neonates) underwent IV cannulation and received 0.5 ml of sucrose solution. Sucrose was administered 1 minute before the procedure drop-by-drop onto the anterior tongue, followed by non-nutritive sucking with a sterilized pacifier. The sucrose was intended to control pain during the procedure and provide continued pain relief after the procedure. The analgesic effect of sucrose is expected to last for approximately 3–5 minutes after administration, based on existing evidence. A group using pharmacologic agents like EMLA was not included to focus on assessing sucrose as a non-pharmacological option for neonatal pain relief. This approach ensures a clear evaluation of sucrose's effectiveness without interference from other treatments. No anesthesia was used during the procedures. Rescue analgesia refers to additional interventions such as acetaminophen or local anesthetics employed when the initial pain relief strategy is insufficient. Studies suggest that sucrose effectively reduces procedural pain in neonates during minor procedures like venipuncture or cannulation, minimizing the need for rescue analgesia. In our study, no neonates required rescue analgesia. IV fluids containing glucose were temporarily discontinued to ensure accurate measurement of sucrose's analgesic effects. All neonates with obstructive conditions, such as Hirschsprung disease and intestinal atresia, were managed with nasogastric tube decompression, ensuring their condition was not influenced by the minimal dose of sucrose. The primary outcome, pain intensity, was assessed using the Premature Infant Pain Profile (PIPP) at 1 minute post-procedure. Data were analyzed using SPSS version 25.0.

Results: A 0.5 ml dose of 24% sucrose significantly reduced PIPP scores compared to a 0.2 ml dose, with mean scores of 3.57 ± 1.61 and 8.74 ± 2.03, respectively (p < 0.0001). Additionally, a significant correlation was found between the age and weight of neonates and their PIPP scores (p < 0.05).
Conclusion: A 0.5 ml dose of 24% sucrose is more effective than 0.2 ml for managing procedural pain in neonates. The findings provide evidence for using sucrose as a safe, non-pharmacological analgesic in neonatal care.