Does topical amethocaine gel reduce the pain of venepuncture in newborn infants? A randomised double blind controlled trial
A Jain, N Rutter
Department of
Neonatal Medicine, Nottingham City Hospital, Hucknall Road, Nottingham
NG5 1PB, UK
Correspondence to: Dr Jain email: anoo.jain{at}nottingham.ac.uk
Accepted 15 May 2000
BACKGROUND
Topical
amethocaine provides effective pain relief during venepuncture in
children, and has been shown to have a local anaesthetic action in the newborn.
AIMTo investigate the
effect of topical amethocaine on the pain of venepuncture in the newborn.
DESIGNRandomised
double blind placebo controlled trial.
SUBJECTSForty newborn
infants, gestation 27-41 weeks (median 33), age 2-17 days (median 7),
undergoing routine venepuncture.
METHODA 1.5 g portion
of 4% (w/w) amethocaine gel (Ametop; Smith and Nephew, Hull, UK) or
placebo was applied to the skin under occlusion for one hour, then
wiped away. Venepuncture was performed five minutes later. Facial
reaction and cry were recorded on videotape. Pain was assessed using a
validated adaptation of the neonatal facial coding system. Five
features were scored at one second intervals for five seconds before
and after venepuncture. No or minimal pain was defined as a cumulative
score of below 10 (out of 25) in the five seconds after needle
insertion. Each author scored the tapes independently.
RESULTSThere was
close agreement on scoring of the tapes. One infant was excluded
because of restlessness before the venepuncture. Of 19 amethocaine
treated infants, 16 (84%) showed little or no pain compared with six
of 20 (30%) in the placebo group (p = 0.001). The median cumulative
neonatal facial coding system score over five seconds after needle
insertion was 3 compared with 16 in the placebo group (p = 0.001). Of
the 19 amethocaine treated infants, 15 (79%) did not cry compared with
five of 20 (25%) placebo treated infants (p = 0.001). No local
reaction to amethocaine was seen.
CONCLUSIONTopical
amethocaine provides effective pain relief during venepuncture in the newborn.
Keywords: amethocaine; anaesthetic; pain; venepuncture
© 2000 by Archives of Disease in Childhood
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