Editor—The study of Jain and Rutter1 indicates that, after an hour of application, topical amethocaine gel exerts a demonstrable anaesthetic effect 54.8% of the time, indicating low potential for practical use. In the authors' own words “a successful . . . anaesthetic should be quick acting, effective and safe . . .”.

It is therefore disappointing to note that in the discussion no mention was made of oral sucrose as an analgesic agent for use in neonates undergoing painful procedures. This is despite a large body of evidence suggesting that it reduces the indicators of pain from various sources.2 ,3 Unfortunately there is a widespread reluctance of clinicians to use oral sucrose before performing painful procedures on neonates. We showed this in a recent study.4

Questionnaires were sent to the medical directors of the 18 neonatal units in New Zealand in order to determine the knowledge, attitudes, and practice with regard to commonly performed painful neonatal procedures such as blood taking or line placement. In the 15 replies, there was a high degree of awareness that the procedures caused pain (100%), that the physiological stress of pain was more hazardous than the risks of analgesia (67%), and that oral sucrose was a safe and effective analgesic (87%); and yet only five units (33%) ever used any type of analgesia for these procedures and usually for less than 10% of the time. Only one unit (our own) used oral sucrose routinely. We find it to be highly effective, simple to use, and rapid in action. It is also exceedingly cheap.

We do not know why oral sucrose has failed to find much favour in neonatal units. Clearly neither lack of understanding of neonatal pain perception nor lack of knowledge about the analgesic properties of sucrose are significant factors. Perhaps there is an unrecognised prejudice against anything that is low tech, cheap, and not promoted by pharmaceutical companies.