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Am Fam Physician. 2003;67(5):1091-1092

Venipuncture is often necessary in the neonatal intensive care unit. Because current evidence suggests that neonates experience pain, efficient, rapidly effective pain control is warranted. The efficacy of EMLA (local anesthetic cream) has not been definitely established. Furthermore, it must be applied 60 minutes before a procedure. A study undertaken by Gradin and colleagues compares the effect of orally administered glucose with EMLA in preventing pain during venipuncture.

The group conducted a randomized, controlled, double-blind study, enrolling 201 term infants older than 24 hours but less than 30 days of age at entry to the study. One group was given EMLA on the skin and oral placebo 60 minutes before venipuncture. The second group was given a 1-mL dose of 30 percent oral glucose orally and a placebo on the skin just before the procedure. Pain was measured by the duration of crying after venipuncture and by a premature infant pain profile (PIPP) that measured facial actions, heart rate, and oxygen saturation.

There were 99 infants in the EMLA group and 102 in the glucose group who completed the study. PIPP scores were significantly lower in the glucose group than in the EMLA group. Only 19.3 percent of the glucose group had pain (as measured by a PIPP score of greater than 6) compared with 41.7 percent in the EMLA group. Duration of crying in the first three minutes was significantly shorter in the glucose group than in the EMLA group (median 1 second, range 0 to 180 versus 18 seconds, range 0 to 176, respectively). Infants in both groups had increased heart rate with no other significant differences.

Gradin and colleagues conclude that glucose is more effective in reducing pain symptoms during newborn venipuncture than EMLA, a finding that supports previous observations. Endorphin release activated by the sweet-tasting solution may account for the analgesic effect.

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