NEW YORK (Reuters Health) – Oral sucrose remains effective over time for easing pain associated with repeated heel sticks in preterm infants, a new study shows.
“Facilitated tucking” (FT), on the other hand, is not an effective non-pharmacologic intervention for pain relief in preterm infants and cannot be recommended, either alone or in combination with oral sucrose, the investigators say.
With FT, a nurse places a hand on the infant’s hands and feet and tucks the limbs close to the trunk while in either a side-lying, supine or prone position. FT provides the infant with support and the chance to control his or her own body and research suggests that it helps stabilize behavioral and physiologic states during painful procedures.
In an email to Reuters Health, Dr. Eva Cignacco and Gila Sellam, a research assistant and doctoral student, from the Institute of Nursing Science, University of Basel, Switzerland, who worked on the study, noted that performing FT takes “high staff resources” — one nurse carrying out the painful procedure and one nurse tucking the child two to three minutes before the procedure, during the procedure and two to three minutes after the procedure.
“Considering the usual high workload in neonatal intensive care units (NICUs) and the restrictions in staffing, we cannot recommend FT alone as a feasible pain relieving intervention,” they say.
In their study, the combination of sucrose and FT was more effective in reducing pain than sucrose alone, particularly in the recovery phase after the heel stick, but the difference was not clinically relevant.
“In light of the usually busy NICU setting, we would not recommend the combination of oral sucrose and FT as a ‘must.’ However, FT could be added to oral sucrose by involving parents in their child’s pain management, which would promote the bond between the infant and parent,” they suggest.
Over the first 14 days in the NICU, the investigators and their colleagues compared the pain-easing effects of oral sucrose (0.2 mL/kg) and FT alone and in combination across five heel stick procedures in 71 preterm infants between 24 and 32 weeks of gestation.
They videotaped each infant during three phases (baseline, heel stick and recovery) and the videotapes were rated by four experienced nurses.
As reported in the February issue of Pediatrics, available online now, FT alone was significantly less effective in relieving repeated procedural pain (P < 0.002) than sucrose.
The combination of FT and sucrose “seemed to have added value in the recovery phase with lower pain scores (P = 0.003) compared with both single treatments, but again the differences weren’t clinically meaningful, the researchers say.
“Although there are promising findings regarding FT as an effective non-pharmacologic intervention, the challenges of this specific intervention in nursing practice need to be reconsidered in an environment characterized by economic constraints,” they conclude.
Dr. Cignacco and Ms. Sellam commented that this study is one of the first to show the effectiveness of oral sucrose as a non-pharmacological pain relief intervention over repeated painful procedures.
SOURCE:
Pediatrics 2012;129:1-10.
