Oral sucrose compares favourably with lidocaine-prilocaine cream for pain relief during venepuncture in neonates

To compare the relative efficacy of oral sucrose versus EMLA(R) cream for p ain relief during venepuncture, 51 full-term newborns (38M, 13F; postnatal age <4 d) in a stable condition were randomly allocated to one of four trea tment groups: placebo (2 ml spring water): 2 ml sucrose 24% w/v; 1 g lidoca ine-prilocaine 5% cream (EMLA); or EMLA plus sucrose. Water or a single dos e of sucrose solution was administered orally 2 min before venepuncture. EM LA cream was applied in the antecubital fossa 45-60 min before venepuncture and covered by a Tegaderm(R) dressing. A pacifier was given before skin pu ncture, but it was not actively held or replaced during the procedure or ob servation periods. In total, 55 venepunctures were performed blindly, alway s for clinical reasons. As indicators of pain, the total crying time was re corded and heart rate, respiratory rate and arterial oxygen saturation were measured blindly at baseline, immediately post-venepuncture, and 2 and 4 m in afterwards. The main effects observed were: (i) time spent crying decrea sed significantly in the sucrose alone (p = 0.001) and EMLA plus sucrose (p = 0.008) groups; (ii) the above treatments attenuated significantly (p < 0 .05) the immediate heart rate response to pain; and (iii) the concomitant u se of EMLA did not increase further the analgesic efficacy of sucrose. Conclusion: This study shows that a 24% oral sucrose solution compares favo urably with EMLA cream as a safe and cheap analgesic procedure to decrease pain responses to venepuncture in newborns.