Glucose analgesia?

[melclin]

I was speaking with a paramedic recently who mentioned a practice common at the children's hospital: using glucose paste (or maybe sucrose, if that makes any difference) as a mild analgesic for babies and toddlers. Apparently there isn't any literature on the matter, although I've not looked myself, but its common practice.

Anyone heard of this/seen this/ done this before? Opinions?

[Timmy]

I've never heard of this, interesting thought though. Maybe it's used more as a diversional therapy?

[melclin]

I've never heard of this, interesting thought though. Maybe it's used more as a diversional therapy?

I would imagine so, although I get the impression that there was some suggestion by the nurse in the story that it was a bit more than that. Hence my interest. But yeah I'd put my money on the post-vaccination-lollie-pop effect being involved here.

[WolfmanHarris]

Maybe their the fentanyl lollypops? Otherwise I've never heard of this. I'll pop it into pubmed, but I have my doubts.

Edit: I'm surprised as heck to say this, but I found a reference to glucose as an analgesic. Will keep searching, but for now look in the results section of this abstract.

Edit 2: Very interesting indeed. Take a look at this abstract. Makes me wonder what the underlying cause might be. My current off the cuff thinking is that the glucose plus pacifier technique has more to do with enhanced distraction than an actual relief of pain. Still useful though. The search continues.

Edit 3: Clinical guidelines for glucose analgesia.

Edit 4: Maybe I should save these up, but I keep intending to go out the door and google keeps distracting me with more tidbits. Apparently glucose does not act on opiate receptors, as naxolone does not affect it.Read here. Hypothesized in another study that the relationship between glucose and opiod receptors is indirect and that glucose may result in the release of endogenous opiods.

Edited November 28, 2009 by docharris

[fireflymedic]

Doc - nice there. I'm gonna dig a little more and do some investigation myself. thanks for the linkage.

[croaker260]

I have heard/seen this in the NICU. I do not know, nor have I heard of it being used in older populations, but my own daughter (who was in NICU for 6-7 weeks) received this for several procedures. Apparently it is a common practice in this age group. I asked about it but didn't get a good answer, but then by then I was butting heads with the NICU staff on a daily basis anyway (apparently I'm hardheaded becauseI like to be involved in my daughters medical progress...)

[frogman]

Thats an interesting thought, have you found any interesting and supportive papers on this issue.

[Aussieaid]

We used to use Sweet Ease (a form of sucrose) for the babies in our PICU when we were going to do minor procedures such as line placements or IV starts.

Here is one study done on the topic.

Sweet Ease is what we used.

This study mentions sucrose for pain management in infants.

I wonder if it would be an option in the prehospital setting since you can actually buy it for infants at home (I think).

Cheers

[melclin]

Thanks guys very interesting.

I've had a look around now myself. I don't know what the medic I was talking to was on about when she said there wasn't any literature on it. There's plenty.

Sucrose is safe and effective for reducing procedural pain from single painful events (heel lance, venepuncture)......Sucrose provides pain relief for newborn babies having painful procedures such as needles or heel lances. Newborn babies undergoing painful procedures need help to have their pain reduced. This is done routinely for major procedures but may not be done for tests (such as taking blood) or needles. Drugs can be used to reduce pain but there are several other methods including sucking a pacifier with or without sucrose (sugar). The review of trials found that giving sucrose to babies decreases their crying time and other pain indicators such as facial action. More research is needed into the effect of repeated doses of sucrose, especially for very low birthweight or ventilated babies.

Stevens B, Yamada J, Ohlsson A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD001069. DOI: 10.1002/14651858.CD001069.pub2

A quick google books search with the term "sucrose analgesia" provides a long list of paeds and neonates texts with substantial discussion of Sucrose analgesia.

[tniuqs]

I have heard/seen this in the NICU. I do not know, nor have I heard of it being used in older populations, but my own daughter (who was in NICU for 6-7 weeks) received this for several procedures. Apparently it is a common practice in this age group. I asked about it but didn't get a good answer, but then by then I was butting heads with the NICU staff on a daily basis anyway (apparently I'm hardheaded because I like to be involved in my daughters medical progress...)

Well croaker, I have worked in NICU I could not I agree with you MORE ... BE involved and BE hard headed, it is as and the end of the day YOUR child !

To the OP, OK so you asked for opinion well here is my 2 cents:

Notoriously in medicine and especially in the pediatric population the "under dose" of proper and proven analgesia remains a huge issue, I must agreed this is delusional and/or diversional therapy. Even the pathways of Brown Fat metabolism is not fully understood let alone the use of "sugar" affecting opiate receptors.

Well just me I would go with the Fentanyl sucker over candy any day.

Please look to the "studies" in this case just what is the "judgement" criteria in the first place ? Honestly an EPIC FAIL, from the links presented is no logical criteria being evaluated ? IMHO some studies should be turfed based on that criteria alone, straight up many study for study sake should be filed under "G" and not worth the trees that are killed to print it.

Forget heel lance to start with as as a infant its difficult to cry with something in your mouth maybe try a controlled study in the adult demographic for comparison in doing a circumcising or do an LP in an adult and just see how that goes ?

Ongoing Analgesia for the Mechanically Ventilated Infant

It is unclear whether mechanical ventilation is a painful experience in premature infants, and there is controversy about whether ongoing analgesic therapy should be the standard of care for the ventilated preterm infant.

Right then, put a tube into a trachea then another suction cath to further irritate airways is unclear if its painful or at least "uncomfortable" ?????? Why do I have an overwhelming need to bitch slap someone ? Oddly enough with Brads and Desats the first "technique" used is physical stimulation ... need I say more ?

But I will ...

The Miami Valley Hospital NICU "Pain Team" observed unexplained episodes of hyperglycemia in ventilated preterm infants. The episodes seemed to improve with morphine administration and raised concerns that untreated pain was the cause of the hyperglycemia.

REALLY ... rocket scientists at work here ?

Bottom line for me is this, THE GREAT SPIRIT <insert your personal belief> WELL He/She put the poppy on this planet for a reason and I will use it before a "sugar pill"

ps The now controversial Placebo Effect used "sugar pills" as a a control, weird ain't it ?

cheers