[Analgesic effects of Emla cream and saccharose solution for subcutaneous injections in preterm newborns: a prospective study of 265 injections].
OBJECTIVE
To compare the analgesic effects of non nutritive pacifier sucking, oral administration of a 30% saccharose solution, local application of Emla and their association for subcutaneous injection of erythropoietin (EPO) in preterm infants.


METHODS
Our study was a randomised, prospective study conducted over 5 months. Neonates with a gestational age below 33 weeks of gestation and older than 8 days of life were included if they were treated with EPO (three subcutaneous injections per week during 6 weeks). For each consecutive EPO injection, patients were randomised between four groups of intervention: non nutritive pacifier sucking (T), oral administration of 0.2-0.5 ml of a 30% saccharose solution with non nutritive pacifier sucking (S), local application of Emla with non nutritive pacifier sucking (E), and oral administration of 0.2-0.5 ml of a 30% saccharose solution with local application of Emla and with non nutritive pacifier sucking (S + E). Each child was its own control. Pain was assessed with the Newborn Acute Pain scale (DAN) and with the Neonatal Facial Coding System (NFCS).


RESULTS
Thirty-three neonates were included, representing 265 injections. Distribution was: 41 in group T, 71 in group E, 86 in group S and 67 in group E + S. Mean DAN and NFCS scores were statistically different between groups T, E and S. Analgesic effect of saccharose (-1.05) was greater than Emla (-0.56). Used together, effects were adding up without potentialisation.


CONCLUSIONS
This study shows that the association of non nutritive pacifier sucking with oral administration of saccharose and local application of Emla has a better analgesic effect than each of these three interventions alone for subcutaneous injection of EPO.
Service de néonatologie, hôpital Armand-Trousseau, AP-HP, 26, avenue du Dr-Arnold-Netter, 77571 Paris cedex 12, France. v.mucignat@trs.ap-hop-paris.fr
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Mucignat
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Ducrocq
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Lebas
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Mochel
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Baudon
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Gold
D000279:Administration, Cutaneous; D000284:Administration, Oral; D000704:Analysis of Variance; D019162:Anesthetics, Combined / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D004921:Erythropoietin / Q000008:administration & dosage; D005149:Facial Expression; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D007279:Injections, Subcutaneous / Q000009:adverse effects*; D008012:Lidocaine / Q000627:therapeutic use*; D000077442:Lidocaine, Prilocaine Drug Combination; D008297:Male; D041361:Pacifiers / Q000592:standards*; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement / Q000379:methods; D011318:Prilocaine / Q000627:therapeutic use*; D011446:Prospective Studies; D012996:Solutions; D013391:Sucking Behavior; D013395:Sucrose / Q000627:therapeutic use*; D016896:Treatment Outcome
D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D000077442:Lidocaine, Prilocaine Drug Combination; D012996:Solutions; D011318:Prilocaine; D004921:Erythropoietin; D013395:Sucrose; D008012:Lidocaine