Topical amethocaine gel for pain relief of heel prick blood sampling: a randomised double blind controlled trial
A Jain, N Rutter, M Ratnayaka
Department of
Neonatal Medicine, Nottingham City Hospital, Hucknall Road, Nottingham
NG5 1PB, UK
Correspondence to: Dr Jain anoo.jain{at}nottingham.ac.uk
Accepted 25 July 2000
BACKGROUND
Heel
prick blood sampling is a commonly performed and painful procedure in
the newborn infant. Use of a topical local anaesthetic does not relieve
this pain. A 4% w/w amethocaine gel (Ametop) reduces the pain of
venepuncture in the newborn but has not been tried with heel pricks.
AIMTo investigate the
effect of topical amethocaine gel on the pain of heel prick in the
newborn infant.
DESIGNRandomised,
double blind, placebo controlled trial.
SUBJECTSSixty newborn
infants, gestation 28-42 weeks (median 36), postnatal age 1-16 days
(median 5) undergoing routine heel prick blood sampling.
METHODSA 1.5 g
portion of 4% w/w amethocaine gel or placebo was applied to the skin
under occlusion for one hour, then wiped away. Heel prick blood
sampling with a spring loaded lance was performed five minutes later.
The procedure was videotaped and pain assessed at one second intervals
using an adaptation of the neonatal facial coding system (NFCS). No or
minimal pain was defined as a cumulative score of less than 5 (out of
15) in the three seconds after firing of the lance and as lack of a cry
in the first five seconds.
RESULTSIn terms of a
low NFCS core and lack of cry (p = 0.12) 20 of 30 (67%) in the
amethocaine group and 13 of 29 (45%) in the placebo group had no or
minimal pain in response to the heel prick. The median cumulative NFCS
score over the three seconds after firing the lance was 3 (interquartile range 0-6) in the amethocaine group compared with 5 (interquartile range 1-10) in the placebo group (p = 0.07). These
differences are not significant.
CONCLUSIONSTopical
amethocaine gel does not have a clinically important effect on the pain
of heel prick blood sampling and its use for this purpose cannot
therefore be recommended. Alternative approaches to the relief of pain
from this procedure should be explored.
Keywords: heel prick; pain; anaesthetic; amethocaine gel
© 2001 by Archives of Disease in Childhood
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This article has been cited by other articles:
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