Comparison of the effect of local anesthetic cream and orally administered glucose solution in reduction of pain in icteric newborns during venipuncture

A number of studies have shown that orally administered sweet-tasting solutions reduce feeling of pain during invasive procedures. The local anesthetic cream EMLA has recently been shown to be safe for use in neonates. The present study aimed to compare the pain-reducing effect of EMLA cream with that of orally administered glucose during venipuncturing of newborns in Yazd city. A randomized, controlled, double blind clinical trial was performed on 220 newborns undergoing venipuncture for clinical reasons. EMLA cream was applied to the skin of 106 of the newborns, along with orally administered sterile water as placebo. In addition, a 30% solution of glucose was administered orally to 114 neonates whose skin was treated with vitamin A+D cream as placebo. Symptoms associated with pain while venipuncturing measured by Neonatal/ Infant pain scale [NIPS] and crying time was compared between the two groups. There were no differences in background variables between the 2 groups. The results showed that the NIPS scores were significantly lower in the glucose group [Median: 2] compared with the EMLA group [median: 3] [p<0.001]. The duration of crying in the first 2 minutes was significantly lower [p<0.01] in the glucose group [median: 2 sec] than in EMLA group [median: 9 sec]. The NIP values higher than 3 were observed in 12.3% and 29.2% of neonates in glucose and EMLA groups respectively, where the difference was found to be statistically significant [p<0.05]. Our study showed that compared with EMLA cream, orally administered glucose can be more effective, tolerable and convenient in reducing pain from venipuncturing in neonates

[Comparison of the effectiveness of oral sucrose and EMLA cream in reduction of a cute pain due to heel sticks for blood sampling in neonates]

Certain painful, invasive procedures are necessary for care, and are commonly performed in both healthy and sick neonates. Current evidence shows that the newborn infant has both physiologic and anatomic capacity to experience pain. Recent research suggests that pain experienced in the neonatal period might have long-term effects later in life. Previous research has shown that orally administered sweet-tasting solutions reduce signs of pain during painful procedures. This effect is considered to be mediated both by the release of endorphins and by a preabsorptive mechanism related to the sweet taste. This study was a controlled, randomized and double-- blind study on 210 neonates. These newborns were randomly divided into 3 groups; A, Band C. Group A received 2 nil of 25% sucrose orally as well as base cream was applied at the site for heel stick, group B received 2 ml of distilled water and application of EMLA cream, while group C received 2 ml of distilled water and base cream. The heart rates of the newborn were recorded by the cardiac monitor before and after heel stick blood sampling and the duration of crying was determined as well. Pain was scored by DAN scale. There were no differences in demographic characteristics of all neonates. The results showed that the DAN scale was significantly lower in the sucrose group [mean: 3.840] as compared to the EMLA group [mean: 3.366] and the placebo group[5.557], but the difference in the duration of crying was not significantly different in the sucrose group [mean: 10.5 second] and the EMLA group[n can 8.76]. Both sucrose and EMLA are effective in reducing stress associated with heel lancet in newborns, but as sucrose acts faster and is healthier, its usage is proposed in neonates requiring heel sticks for blood sampling