Nuffield Department of Anaesthetics, University of Oxford, Oxford, UK.
Lancet. 2010 Oct 9;376(9748):1225-32. doi: 10.1016/S0140-6736(10)61303-7.
Many infants admitted to hospital undergo repeated invasive procedures. Oral sucrose is frequently given to relieve procedural pain in neonates on the basis of its effect on behavioural and physiological pain scores. We assessed whether sucrose administration reduces pain-specific brain and spinal cord activity after an acute noxious procedure in newborn infants.
In this double-blind, randomised controlled trial, 59 newborn infants at University College Hospital (London, UK) were randomly assigned to receive 0·5 mL 24% sucrose solution or 0·5 mL sterile water 2 min before undergoing a clinically required heel lance. Randomisation was by a computer-generated randomisation code, and researchers, clinicians, participants, and parents were masked to the identity of the solutions. The primary outcome was pain-specific brain activity evoked by one time-locked heel lance, recorded with electroencephalography and identified by principal component analysis. Secondary measures were baseline behavioural and physiological measures, observational pain scores (PIPP), and spinal nociceptive reflex withdrawal activity. Data were analysed per protocol. This study is registered, number ISRCTN78390996.
29 infants were assigned to receive sucrose and 30 to sterilised water; 20 and 24 infants, respectively, were included in the analysis of the primary outcome measure. Nociceptive brain activity after the noxious heel lance did not differ significantly between infants who received sucrose and those who received sterile water (sucrose: mean 0·10, 95% CI 0·04-0·16; sterile water: mean 0·08, 0·04-0·12; p=0·46). No significant difference was recorded between the sucrose and sterile water groups in the magnitude or latency of the spinal nociceptive reflex withdrawal recorded from the biceps femoris of the stimulated leg. The PIPP score was significantly lower in infants given sucrose than in those given sterile water (mean 5·8, 95% CI 3·7-7·8 vs 8·5, 7·3-9·8; p=0·02) and significantly more infants had no change in facial expression after sucrose administration (seven of 20 [35%] vs none of 24; p<0·0001).
Our data suggest that oral sucrose does not significantly affect activity in neonatal brain or spinal cord nociceptive circuits, and therefore might not be an effective analgesic drug. The ability of sucrose to reduce clinical observational scores after noxious events in newborn infants should not be interpreted as pain relief.
Medical Research Council.
许多住院婴儿需要接受多次有创操作。基于其对行为和生理疼痛评分的影响，口腔给予蔗糖常被用于缓解新生儿的操作相关疼痛。我们评估了在新生儿接受急性疼痛操作后，给予蔗糖是否能减轻与疼痛相关的大脑和脊髓活动。
在这项双盲、随机对照试验中，59 名来自伦敦大学学院医院的新生儿被随机分配，在接受临床必需的足跟采血前 2 分钟，分别接受 0.5 mL 24%蔗糖溶液或 0.5 mL 无菌水。随机分配由计算机生成的随机分配码进行，研究人员、临床医生、参与者和家长对溶液的身份均设盲。主要结局为通过时间锁定足跟采血记录的单次足跟采血引起的与疼痛相关的大脑活动，并通过主成分分析来识别。次要措施包括基线行为和生理指标、观察性疼痛评分（PIPP）和脊髓伤害性反射退缩活动。数据按方案进行分析。本研究已注册，编号 ISRCTN78390996。
29 名婴儿被分配接受蔗糖，30 名婴儿接受无菌水；分别有 20 名和 24 名婴儿纳入主要结局指标的分析。接受蔗糖和接受无菌水的婴儿在接受疼痛性足跟采血后的痛觉大脑活动无显著差异（蔗糖：均值 0.10，95%CI 0.04-0.16；无菌水：均值 0.08，0.04-0.12；p=0.46）。记录到从受刺激腿的肱二头肌中记录到的脊髓伤害性反射退缩的幅度或潜伏期在蔗糖组和无菌水组之间也没有显著差异。与接受无菌水的婴儿相比，接受蔗糖的婴儿的 PIPP 评分显著更低（均值 5.8，95%CI 3.7-7.8 对比 8.5，7.3-9.8；p=0.02），且在给予蔗糖后，更多的婴儿面部表情无变化（7 名/20 [35%]对比 0 名/24；p<0.0001）。
我们的数据表明，口服蔗糖不能显著影响新生儿大脑或脊髓伤害性回路的活动，因此可能不是一种有效的镇痛药物。蔗糖在新生儿疼痛事件后降低临床观察评分的能力不应被解释为疼痛缓解。
医学研究理事会。
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