Effectiveness of Oral Sucrose for Pain Management in Infants During Immunizations
College of Nursing & Health, Wright State University, Dayton, OH 45435, USA.Pain management nursing: official journal of the American Society of Pain Management Nurses (Impact Factor: 1.53). 09/2012; 13(3):139-49. DOI: 10.1016/j.pmn.2010.07.008
This study examined the effects of oral sucrose as an analgesic agent during routine immunization for infants at 2, 4, and 6 months of age. A sample of 113 healthy infants were recruited from three ambulatory clinics and randomly assigned to one of three treatment groups. Infants were given 2 mL orally of either 50% sucrose, 75% sucrose, or sterile water 2 minutes before administration of immunizations. No significant difference was found among the different age groups with the different treatments for pain as measured with the FLACC scores and crying time. Consolability factors are felt to have some influence.
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ABSTRACT: The aim of this study was to evaluate the effectiveness of oral sucrose in decreasing pain during minor procedures in infants of 1-6 months corrected age. A blinded randomized controlled trial with infants aged 4-26 weeks who underwent venipuncture, heel lance or intravenous cannulation were stratified by corrected age into >4-12 weeks and >12-26 weeks. They received 2 mL of either 25% sucrose or sterile water orally 2 minutes before the painful procedure. Nonnutritional sucking and parental comfort, provided in adherence to hospital guidelines, were recorded. Pain behavior was recorded using a validated 10 point scale at baseline, during and following the procedure. Data collectors were blinded to the intervention. A total of 21 and 20 infants received sucrose and water, respectively, in the >4-12-week age group, and 21 and 22, respectively, in the >12-26-week age group. No statistical differences were found in pain scores between treatment and control groups at any data collection points in either age group. Infants aged >4-12 weeks who did nonnutritional sucking showed statistically significantly lower median pain scores at 1, 2, and 3 minutes after the procedure than those who did not suck. Infants aged >4-26 weeks exhibited pain behavior scores that indicated moderate to large pain during painful procedures; however, there was insufficient evidence to show that 2 mL 25% sucrose had a statistically significant effect in decreasing pain. Infants should be offered nonnutritional sucking in compliance with the Baby Friendly Health Initiative during painful procedures.Pain management nursing: official journal of the American Society of Pain Management Nurses 12/2013; 14(4):e95-e105. DOI:10.1016/j.pmn.2011.08.002 · 1.53 Impact Factor
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ABSTRACT: The FLACC scale is one of the most widely used behavioural observation pain scales. However, the psychometrics of the scale have not been adequately summarised and evaluated to provide clear recommendations regarding its use. to rigorously evaluate the reliability, validity, feasibility and utility of the scale for clinical and research purposes and provide recommendations regarding appropriate use of the scale. Databases searched were; MEDLINE, CINAHL, Embase, PsycINFO (using the Ovid, PubMed and Ebscohost platforms), The Cochrane Database of Systematic reviews and Cochrane Controlled Trials and Google Scholar. Psychometric evaluation studies reporting, feasibility, reliability validity or utility data for the FLACC scale applied to children (birth to 18 years) and randomised controlled trials (RCT) using the FLACC scale to measure a study outcome in infants and children. Data extraction included; study design, population demographics and psychometric data. Analysis involved; quality assessment of the psychometric evaluation studies and the RCTs using the COSMIN checklist and the Jadad Scale respectively and narrative synthesis of all results. Twenty-five psychometric evaluations studies and 52 RCTs were included. The study population, circumstances and quality of the studies varied greatly. Sufficient data addressing postoperative pain assessment in infants and children exists. Some positive data details the psychometrics of the scale used to assess postoperative pain in children with cognitive impairment. Limited and conflicting data addressing procedural pain assessment exist. Content validity and scale feasibility have had limited psychometric evaluation. There is insufficient data to support the FLACC scale for use in all of the circumstances and populations to which is currently applied.Pain 07/2015; DOI:10.1097/j.pain.0000000000000305 · 5.21 Impact Factor
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ABSTRACT: Objective: Tympanostomy tube insertion is the most common pediatric surgery, but it typically requires general anesthesia. To facilitate in-office tube placement without general anesthesia, two complementary technologies have recently been developed comprising an iontophoresis system for delivering local anesthesia and an integrated tube delivery system. The purpose of this study was to evaluate behavioral support techniques used during a clinical study of the new technology for pediatric in-office tube placement without general anesthesia or physical restraints. Methods: As part of an IRB-approved, prospective, nine-center clinical study, pediatric patients requiring tube insertion underwent in-office treatment using the new procedure. The behavior management techniques included preparation, distraction, coaching, and reinforcement for cooperation. The entire procedure was videotaped and two independent coders used the validated FLACC (Face, Legs, Activity, Cry, Consolability) scale to code behavioral distress across five procedural phases. Results: Seventy pediatric patients aged 8 months to 17 years (M=7.0 years; 51% female) were enrolled in the study and 68 had video recordings available for analysis. Of the 68 recordings analyzed, 63 patients completed the procedure and had tubes placed without sedation. Mean FLACC scores ranged from 0.05 to 2.38 (M=1.25, SD=0.82) and median FLACC scores ranged from 0 to 1 (Mdn=0, IQR=0.05), which indicate "mild" distress. During iontophoresis, eardrum tap (anesthesia assessment), and tube delivery, older children displayed lower distress and girls had higher FLACC scores during the eardrum tap procedural phase. Conclusion: When combined with the evidence-based behavioral techniques, office-based local anesthesia and tube delivery resulted in minimal distress, suggesting that the new procedure may be a viable method of conducting tympanostomy tube placement in children without having to use general anesthesia. Clinicaltrials.gov identifier: NCT01496287.International journal of pediatric otorhinolaryngology 10/2015; DOI:10.1016/j.ijporl.2015.09.041 · 1.19 Impact Factor
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