psd-502 and Infant--Premature--Diseases

Topics: Analgesia; Anesthetics, Local; Catheterization, Central Venous; Glucose; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Pain Measurement; Prilocaine

To compare the analgesic effects of non nutritive pacifier sucking, oral administration of a 30% saccharose solution, local application of Emla and their association for subcutaneous injection of erythropoietin (EPO) in preterm infants.. Our study was a randomised, prospective study conducted over 5 months. Neonates with a gestational age below 33 weeks of gestation and older than 8 days of life were included if they were treated with EPO (three subcutaneous injections per week during 6 weeks). For each consecutive EPO injection, patients were randomised between four groups of intervention: non nutritive pacifier sucking (T), oral administration of 0.2-0.5 ml of a 30% saccharose solution with non nutritive pacifier sucking (S), local application of Emla with non nutritive pacifier sucking (E), and oral administration of 0.2-0.5 ml of a 30% saccharose solution with local application of Emla and with non nutritive pacifier sucking (S + E). Each child was its own control. Pain was assessed with the Newborn Acute Pain scale (DAN) and with the Neonatal Facial Coding System (NFCS).. Thirty-three neonates were included, representing 265 injections. Distribution was: 41 in group T, 71 in group E, 86 in group S and 67 in group E + S. Mean DAN and NFCS scores were statistically different between groups T, E and S. Analgesic effect of saccharose (-1.05) was greater than Emla (-0.56). Used together, effects were adding up without potentialisation.. This study shows that the association of non nutritive pacifier sucking with oral administration of saccharose and local application of Emla has a better analgesic effect than each of these three interventions alone for subcutaneous injection of EPO.

Topics: Administration, Cutaneous; Administration, Oral; Analysis of Variance; Anesthetics, Combined; Anesthetics, Local; Combined Modality Therapy; Drug Therapy, Combination; Erythropoietin; Facial Expression; Female; Gestational Age; Humans; Infant, Newborn; Infant, Premature, Diseases; Injections, Subcutaneous; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pacifiers; Pain; Pain Measurement; Prilocaine; Prospective Studies; Solutions; Sucking Behavior; Sucrose; Treatment Outcome

We report on a retrospective analysis of eight episodes of toxic methaemoglobinaemia in seven premature infants after the combined exposure to prilocaine by EMLA cream (12.5 mg prilocaine) and caudal anaesthesia (5.4-6.7 mg/kg prilocaine). The causative relationship between prilocaine and the infants' deterioration came to our attention through an anonymous voluntary incident-reporting system. The highest methaemoglobin concentration found was 30.6% (5.5 h after anaesthesia). All infants were symptomatic (mottled skin, paleness, cyanosis, poor peripheral perfusion) and two were exposed to unnecessary diagnostic and therapeutic procedures for unspecified deterioration in their conditions. Pharmacokinetic evaluation indicated a single compartment first-order elimination with a methaemoglobin half-life of 8 h. Normal levels (<1%) were reached 36 h after exposure to prilocaine.. Whereas local skin application of prilocaine to premature babies is safe, peridural administration is not because premature infants are more sensitive to methaemoglobin inducing agents and tolerate methaemoglobinaemia less well.

Topics: Anesthesia, Caudal; Anesthetics, Local; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Lidocaine; Lidocaine, Prilocaine Drug Combination; Methemoglobinemia; Prilocaine; Retrospective Studies; Time Factors