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Clinical Journal of Pain:
doi: 10.1097/AJP.0000000000000126
Original Article: PDF Only

Randomized Placebo Controlled Trial of Sucrose Analgesia on Neonatal Skin Blood Flow and Pain Response During Heel Lance.

Lehr, Victoria Tutag BS Pharm, PharmD; Cortez, Josef MD; Grever, William PhD; Cepeda, Eugene MD; Thomas, Ron PhD; Aranda, Jacob V. MD, PhD

Published Ahead-of-Print
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Objectives: To evaluate the effect of oral sucrose on skin blood flow (SBF; perfusion units; PU) measured by Laser Doppler Imager (LDI) in term newborns and pain response (Neonatal Infant Pain Scale score; NIPS) during heel lance, and (2) determine SBF changes during heel lance and (3) the relationship between SBF and NIPS.

Methods: Term infants <=7 days old (n=56) undergoing routine heel lance were randomized to pretreatment with 2.0 mL oral 24% sucrose (n=29) or sterile water (n=27) in a double blinded, placebo-controlled trial from 2005-2007. SBF was assessed by LDI scans and NIPS scores at 10 minutes prior to lance; immediately after lancing, and 5 minutes post-blood extraction. Mean SBF and median NIPS scores compared between groups using General Linear Model or Kruskal-Wallis. Regressions examined the relationship between SBF immediately post-heel lance and NIPS score.

Results: Mean SBF and median NIPS scores immediately post-heel lance were lower in sucrose-treated infants (167.9 PU+/-15.5 vs. 205.4 PU+/-16.0, P=0.09; NIPS 1 (IQR 0-4) vs. NIPS 3 (IQR 0-6), P=0.02) although no significant difference in mean SBF. During heel lance NIPS score was predictive of SBF. An increase of 1 in NIPS score was associated with 11 PU increase in SBF (R2=0.21; P=0.09) for sucrose and 16 PU increase for placebo-treated infants (R2 0.20; P=0.014).

Conclusions: Increased SBF assessed by LDI is a pain response among term neonates following routine heel lance which was not completely attenuated by oral sucrose administration. Increased SBF is associated with NIPS scores. Sucrose analgesic efficacy evidenced by decreased NIPS scores for the sucrose group. Association of SBF with NIPS scores suggests LDI is potentially useful for assessing newborn procedural pain.

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