BACKGROUND: The availability of a safe and effective pharmacological therapy to reduce procedural pain in preterm infants is limited. The effective analgesic single dose of intravenous paracetamol in preterm infants is unknown. Comparative studies on efficacy of different paracetamol doses in preterm infants are lacking. OBJECTIVES: To determine the analgesic effects of different single intravenous paracetamol doses on pain from peripherally inserted central catheter (PICC) placement in preterm infants. METHODS: In a blinded randomized controlled trial, the analgesic effects of 10-, 15-, and 20-mg/kg single-dose intravenous paracetamol before PICC placement were compared in neonates with a gestational age <32 weeks. Secondly, a separate age-matched nonrandomized control group receiving oral sucrose was included. Pain was assessed with the Premature Infant Pain Profile (PIPP) and the COMFORTneo score. Peak plasma concentrations of paracetamol were determined. RESULTS:A total of 60 patients were included in the paracetamol dose groups (median gestational age = 27.8, IQR: 25.7-29.2 weeks). PIPP scores were comparable: median = 8 (IQR: 6-10.5), 7 (IQR: 6-9), and 8 (IQR: 6-10) for the 10-, 15-, and 20-mg/kg paracetamol groups, respectively (p = 0.94). COMFORTneo scores were not statistically different between the different paracetamol dose groups (p = 0.35). All randomized subjects, except for 3 who received 10 mg/kg of paracetamol, had peak paracetamol concentrations >9 mg/L. PIPP (p = 0.78) and COMFORTneo (p = 0.08) scores were also comparable between paracetamol- and sucrose-treated patients. CONCLUSIONS: We found no analgesic benefit from intravenous paracetamol studied in different single doses over sucrose for PICC placement in preterm infants. Paracetamol is not a suitable analgesic for this procedure in preterm infants.
RCT Entities:
BACKGROUND: The availability of a safe and effective pharmacological therapy to reduce procedural pain in preterm infants is limited. The effective analgesic single dose of intravenous paracetamol in preterm infants is unknown. Comparative studies on efficacy of different paracetamol doses in preterm infants are lacking. OBJECTIVES: To determine the analgesic effects of different single intravenous paracetamol doses on pain from peripherally inserted central catheter (PICC) placement in preterm infants. METHODS: In a blinded randomized controlled trial, the analgesic effects of 10-, 15-, and 20-mg/kg single-dose intravenous paracetamol before PICC placement were compared in neonates with a gestational age <32 weeks. Secondly, a separate age-matched nonrandomized control group receiving oral sucrose was included. Pain was assessed with the Premature InfantPain Profile (PIPP) and the COMFORTneo score. Peak plasma concentrations of paracetamol were determined. RESULTS: A total of 60 patients were included in the paracetamol dose groups (median gestational age = 27.8, IQR: 25.7-29.2 weeks). PIPP scores were comparable: median = 8 (IQR: 6-10.5), 7 (IQR: 6-9), and 8 (IQR: 6-10) for the 10-, 15-, and 20-mg/kg paracetamol groups, respectively (p = 0.94). COMFORTneo scores were not statistically different between the different paracetamol dose groups (p = 0.35). All randomized subjects, except for 3 who received 10 mg/kg of paracetamol, had peak paracetamol concentrations >9 mg/L. PIPP (p = 0.78) and COMFORTneo (p = 0.08) scores were also comparable between paracetamol- and sucrose-treated patients. CONCLUSIONS: We found no analgesic benefit from intravenous paracetamol studied in different single doses over sucrose for PICC placement in preterm infants. Paracetamol is not a suitable analgesic for this procedure in preterm infants.
Authors: Susanne Brummelte; Ruth E Grunau; Vann Chau; Kenneth J Poskitt; Rollin Brant; Jillian Vinall; Ayala Gover; Anne R Synnes; Steven P Miller Journal: Ann Neurol Date: 2012-02-28 Impact factor: 10.422
Authors: Daniëlla W E Roofthooft; Sinno H P Simons; Kanwaljeet J S Anand; Dick Tibboel; Monique van Dijk Journal: Neonatology Date: 2014-02-04 Impact factor: 4.035
Authors: Monique van Dijk; Daniella W E Roofthooft; Kanwaljeet J S Anand; Fleur Guldemond; Joke de Graaf; Sinno Simons; Youette de Jager; Johannes B van Goudoever; Dick Tibboel Journal: Clin J Pain Date: 2009-09 Impact factor: 3.442
Authors: Chenguang Wang; Karel Allegaert; Dick Tibboel; Meindert Danhof; Caroline D van der Marel; Ron A A Mathot; Catherijne A J Knibbe Journal: J Clin Pharmacol Date: 2014-01-23 Impact factor: 3.126