Remifentanil for percutaneous intravenous central catheter placement in preterm infant: a randomized controlled trial.
BACKGROUND
There is limited evidence on the analgesic efficacy of opioids during percutaneous intravenous central catheter (PICC) insertion in preterm infants.


OBJECTIVE
To assess the analgesic and procedural efficacy of low-dose remifentanil infusion during PICC in preterm infants.


METHODS
Fifty-four neonates [mean gestational age (+/-sd) 28 +/- 2 weeks; birth weight 1126 +/- 337 g] were randomly assigned to remifentanil infusion at 0.03 mcg.kg(-1).min(-1) (R) or placebo (C) in addition to 0.3 ml of 12% sucrose per os and non-nutritive sucking.


RESULTS
Validated pain scales [Neonatal Infants Pain Scale (NIPS) and Premature Infants Pain Profile (PIPP)] administered at the baseline T0, skin preparation T1, needle insertion T2, and recovery T3, revealed differences in mean NIPS scores (C 5.3 +/- 1.3 vs R 4.2 +/- 1.4 at T1 and C 5.0 +/- 1.3 vs R 3.4 +/- 1.3 at T2) and PIPP scores (C 9.3 +/- 1.6 vs R 7.1 +/- 1.5 at T1 and C 8.6 +/- 1.7 vs R 6.1 +/- 1.4 at T2); P < 0.05. Cardiovascular and respiratory response, and body movements during PICC suggested better pain and distress control with remifentanil (P < 0.05), but the time to complete the maneuver and the number of attempts needed remained the same in the two groups.


CONCLUSIONS
Low-dose remifentanil has a measurable, synergic analgesic effect in combination with 12% sucrose and non-nutritive sucking, but does not make PICC easier or quicker.
Department of Pediatrics, Neonatal Intensive Care, University of Padua, Padua, Italy. lago@pediatria.unipd.it
Paola
P
Lago
Caterina
C
Tiozzo
Giovanna
G
Boccuzzo
Antonella
A
Allegro
Franco
F
Zacchello
D000698:Analgesia / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D002405:Catheterization, Central Venous / Q000379:methods*; D004311:Double-Blind Method; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D010147:Pain Measurement / Q000379:methods; D010880:Piperidines / Q000008:administration & dosage*; D000077208:Remifentanil; D012119:Respiration / Q000187:drug effects; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D010880:Piperidines; D000077208:Remifentanil