title: A randomized controlled trial of sucrose and/or pacifier as analgesia for infants receiving venipuncture in a pediatric emergency department.
abstract: BACKGROUND
  Although sucrose has been accepted as an effective analgesic agent for procedural pain in neonates, previous studies are largely in the NICU population using the procedure of heel lance. This is the first report of the effect of sucrose, pacifier or the combination thereof for the procedural pain of venipuncture in infants in the pediatric emergency department population.
  
  
  METHODS
  The study design was a double (sucrose) and single blind (pacifier), placebo-controlled randomized trial--factorial design carried out in a pediatric emergency department. The study population was infants, aged 0-6 months. Eighty-four patients were randomly assigned to one of four groups: a) sucrose b) sucrose & pacifier c) control d) control & pacifier. Each child received 2 ml of either 44% sucrose or sterile water, by mouth. The primary outcome measure: FLACC pain scale score change from baseline.
  
  
  METHODS
  crying time and heart rate change from baseline.
  
  
  RESULTS
  Sucrose did not significantly reduce the FLACC score, crying time or heart rate. However sub-group analysis revealed that sucrose had a much greater effect in the younger groups. Pacifier use reduced FLACC score (not statistically significant), crying times (statistically significant) but not heart rate. Subgroup analysis revealed a mean crying time difference of 76.52 seconds (p < 0.0171) (0-1 month) and 123.9 seconds (p < 0.0029) (1-3 month). For subgroup age > 3 months pacifier did not have any significant effect on crying time. Age adjusted regression analysis revealed that both sucrose and pacifier had significant effects on crying time. Crying time increased with both increasing age and increasing gestational age.
  
  
  CONCLUSIONS
  Pacifiers are inexpensive, effective analgesics and are easy to use in the PED for venipuncture in infants aged 0-3 months. The benefits of sucrose alone as an analgesic require further investigation in the older infant, but sucrose does appear to provide additional benefit when used with a pacifier in this age group.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN15819627.
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada. scurtis@ualberta.ca
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Curtis
authors.forename: Hsing
authors.initials: H
authors.lastname: Jou
authors.forename: Samina
authors.initials: S
authors.lastname: Ali
authors.forename: Ben
authors.initials: B
authors.lastname: Vandermeer
authors.forename: Terry
authors.initials: T
authors.lastname: Klassen
mesh_terms: D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D041361:Pacifiers; D010146:Pain / Q000503:physiopathology / Q000517:prevention & control*; D010147:Pain Measurement; D018962:Phlebotomy; D012189:Retrospective Studies; D016037:Single-Blind Method; D013395:Sucrose / Q000008:administration & dosage*; D013549:Sweetening Agents / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D013549:Sweetening Agents; D013395:Sucrose