Lingual sucrose reduces the pain response to nasogastric tube insertion: a randomised clinical trial

Abstract

Objective: To determine whether lingual sucrose modifies the pain response to nasogastric tube insertion in preterm infants.

Design: Randomised, double-blind, placebo controlled clinical trial.

Setting: Special care baby unit.

Patients: 20 stable preterm infants who required nasogastric tube insertion for feeding, randomised on 51 occasions.

Intervention: Lingual 24% sucrose or water placebo (0.5–2 ml varying with body weight) administered 2 min before nasogastric tube insertion.

Outcome measures: Heart rate, oxygen saturation (SaO₂), Neonatal Facial Coding Score and presence or absence of cry.

Results: Infants who received sucrose demonstrated a significantly lower Neonatal Facial Coding Score during nasogastric tube passage compared with the placebo group (median 1 (range 0–4) vs 3 (0–4), p = 0.004). There was a trend for sucrose-treated infants to have little change in heart rate during nasogastric tube passage compared with the placebo group (mean (SD) −0.73 (23) vs +11 (17), p = 0.055). Mean SaO₂ did not change significantly. Pain response measurements quickly returned to baseline after nasogastric tube insertion. Adverse effects, such as apnoea or oxygen desaturation, were few and occurred equally in each group.

Conclusions: Nasogastric tube insertion induces a pain response comparable with previously reported responses to heel lance in neonates. Single-dose lingual 24% sucrose is effective in reducing the behavioural and physiological pain response to nasogastric tube insertion in preterm infants and it appears to be safe.