Archives of Pediatric and Adolescent Medicine, 155, 173-180. Sucrose for Neonatal Pain Management P arent / Caregiver Information Neonatal Intensive Care Unit (NICU) Do infants feel pain? Administered orally for relief of pain caused by minor procedures without a physician’s order to infants up to 12 months of age. Use sucrose up to 8 doses in a 24 hours period. Protocol for the use of sucrose solution for procedural pain management Sucrose Reduces distress associated with painful procedures in babies < 3 months of age Is safe, and easily administered. Pain and Sedation Assessment and Management in Newborns Page 5 OF 9 9.2 Anand, K.J.S. Neonatal pain is best managed using a multi-directional approach which can be conceptualized in a tiered manner (see Fig. “When sucrose is used as a pain management strategy, it should be prescribed and tracked as a medication. The idea of using sucrose to control pain has always sort of bothered me. Consistent management of repeated procedural pain with sucrose in preterm neonates: Is it effective and safe for repeated use over time? If a patient has more than 8 procedures in that time frame consider other methods of pain management. 4. They are repeatedly administered to almost all children throughout infancy, childhood and adolescence. 3. The effect may be prolonged by administering 2 or three repeat doses at 2 minute intervals during the procedure. The administration of sucrose with and without non-nutritive sucking (NNS) has been examined for relieving procedural pain in newborn infants. Finding pain-mitigating interventions that are low-cost, effective, and feasible across all settings, including with low-resourced settings could improve primary healthcare. The calming and pain-relieving effects of sucrose are thought to be mediated by endogenous opioid pathways activated by sweet taste. Indications for use Any procedural pain: heel stick, blood procurement, venepuncture, intravenous line insertion, dressing changes, adhesive tape removal, immunisations, suture removal, urinary catheter insertion, nasogastric tube insertion, etc. Objectives: Oral sucrose is commonly used to provide analgesia to neonates during painful procedures, such as venepuncture. Rebeccah Slater and colleagues (Oct 9, p 1225)1 question the benefit of sucrose for alleviating procedural pain in infants. Breastfeeding, sucrose and EBM for procedural pain management. More research is needed to better understand the effects of sucrose use for analgesia,” Keels says. Among the non-pharmacological measures for pain control, the most commonly used were breast milk ad libitum during the procedure , sucrose solution (24–25% sucrose) [22, 30,31,32], dextrose solution (50% dextrose) , non-nutritive sucking (NNS) provided in the form of a gloved finger , and audio-stimulation with music (lullabies or repetitive rhythms) . In my personal experience, I would definitely say that the use of oral sucrose helps to alleviate pain during these procedures and is a great alternative to pharmacological interventions. Because newborns are actually very sensitive to pain, pain management has been stated as a significant part of health care in newborns. Sucrose is not a pain medication. Glucose is also effective in decreasing pain responses, with 20% to 30% glucose solutions reducing pain scores and crying. Purpose: To evaluate the effectiveness of oral sucrose versus breastfeeding as methods of pain management during immunization of infants through 6 months of age. The additional benefits of reducing pain during venepuncture when oral sucrose is combined with nonpharmacological strategies have not been extensively studied. Sucrose is safe and effective for reducing procedural pain from single events. Breastfeeding is preferable when available as parent contact, especially skin to skin provides comfort. 1) and includes non-pharmacologic and pharmacologic modalities (see Table 2).The foundational basis for optimizing pain management in the neonatal population is aimed at reducing the total number of painful events []. It requires us to believe that infants are fundamentally different; to really believe that children are not just small adults. Chapter 3: Oral sucrose for procedural pain Valid until 1st February 2022 3 management in infants. Oral sucrose should be included in paediatric emergency department pain management guidelines as one of the possible strategies to utilise for infants during minor painful procedures. 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