Sucrose Analgesia
Neonates and infants feel pain as intensely as adults do. It is both kind and good medical practice to alleviate discomfort caused by these procedures
Aim
A neonatal / infant hospital admission will typically involve multiple painful procedures. Neonates and infants feel pain as intensely as adults do. It is both kind and good medical practice to alleviate discomfort caused by these procedures.
Criteria
There are several pharmacological and non-pharmacological measures to reduce neonatal and infant pain. Non-pharmacological measures include ensuring, where possible, the patient (neonate/infant) is calm, relaxed, warm, fed and timely completion of procedure, which will be aided by preparing all necessary equipment for the procedure beforehand.
Once non-pharmacological measures have been implemented, oral sucrose analgesia may be considered for patients (neonates/infants) in the clinical setting. Oral sucrose is an effective and safe treatment for reducing neonates and infants’ pain response. The analgesic effects of sucrose and non-nutritive suckling are theorised to be mediated through increase in endogenous endorphins. Oral sucrose will not always eliminate all crying, but can significantly reduce the physiological stress of pain.
Indications for use
Stand alone agent for any anticipated procedural pain e.g. heel pricks, blood sampling, venepuncture, dressing removal/changes, immunisations, nasogastric tube insertion etc.
Adjunct to other analgesics and topical/local anaesthetic for painful procedures.
Contraindications
Neonates with known fructose intolerance
Glucose-galactose malabsorption
Sucrase-isomaltase deficiency
Age > 18 months
Parental refusal
Cautions
Oesophageal atresia or tracheal-oesophageal fistula
Suspected or proven necrotising enterocolitis
Patients with aspiration risks from sedation or illness, and those with altered gag/swallow reflexes
Dose and administration
Oral sucrose liquid (25%)
| Gestational Age (weeks) | Dose | Daily maximum |
|---|---|---|
| < 32 | 0.2 mL | 1 mL |
| 32 - 40 | 0.2 - 0.5 mL | 2.5 mL |
| 40 - 44 | 0.2 - 1 mL | 5 mL |
| Infants 1 - 18 months postnatal age | 1 - 2 mL | 5 mL |
Prescription
Prescribe sucrose 25% solution on the as-required (PRN) page of the patient's medication chart before administration.
Chart dose in mL and daily maximum dose in mL, based on age. Refer to dose table above and administration section below.
Administration
Administer with a 1 mL syringe onto the front of the tongue 2 minutes prior to a painful procedure. Offer a dummy if it is part of the infant's care.
The analgesic effects last 5 - 8 minutes
There is no minimum interval time between doses of oral sucrose
There is no analgesic effect if the sucrose is given directly into the stomach via a nasogastric tube
Storage
Oral sucrose solution 25% should be stored in a refrigerator once opened and discarded 7 days after the bottle has been opened.