Topical amethocaine gel for pain relief of heel prick blood sampling: a randomised double blind controlled trial
Topical amethocaine gel for pain relief of heel prick blood sampling: a randomised double blind controlled trial
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DOI：
10.1136/fn.84.1.f56
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发表时间：
2001-01-01
影响因子：
4.4
通讯作者：
Ratnayaka, M
中科院分区：
文献类型：
--
作者：
Jain, A;Rutter, N;Ratnayaka, M
背景-足跟采血是新生儿常见且痛苦的过程。使用局部麻醉剂不能减轻这种疼痛。一种4%w/w的氨甲喋呤凝胶（Ametop）可减轻新生儿静脉穿刺疼痛，但尚未用于足跟穿刺。目的-研究局部氨甲喋呤凝胶对新生儿足跟穿刺疼痛的影响。设计-随机、双盲、安慰剂对照试验。受试者-60名新生儿，妊娠28-42周（中位数36），出生后1-16天（中位数5），进行常规足跟穿刺采血。方法-将1.5g部分的4%w/w的氨甲卡因凝胶或安慰剂施加到皮肤上，封闭1小时，然后擦去。5分钟后，用弹簧加载的采血枪进行足跟采血。该过程被录像，并使用新生儿面部编码系统（NFCS）的适应在一秒的时间间隔进行疼痛评估。无疼痛或轻微疼痛定义为累积评分小于5分结果-在低NFCS核心和缺乏叫声方面，（p = 0.12）在30例患者中，有20例（67%）在阿地卡因组中，有13例（45%）在安慰剂组中，对足跟针刺反应没有或仅有轻微疼痛。在发射喷枪后3秒内，与安慰剂组中的5分（四分位数范围1-10）相比，阿司卡因组中的中位累积NFCS评分为3分（四分位数范围0-6）（p = 0.07）。这些差异是不显着的。结论-局部阿司卡因凝胶不具有临床上重要的影响，足跟穿刺采血的疼痛，因此不能推荐其用于此目的。应探索缓解该手术疼痛的替代方法。
Background-Heel prick blood sampling is a commonly performed and painful procedure in the newborn infant. Use of a topical local anaesthetic does not relieve this pain. A 4% w/w amethocaine gel (Ametop) reduces the pain of venepuncture in the newborn but has not been tried with heel pricks.Aim-To investigate the effect of topical amethocaine gel on the pain of heel prick in the newborn infant.Design-Randomised, double blind, placebo controlled trial.Subjects-Sixty newborn infants, gestation 28-42 weeks (median 36), postnatal age 1-16 days (median 5) undergoing routine heel prick blood sampling.Methods-A 1.5 g portion of 4% w/w amethocaine gel or placebo was applied to the skin under occlusion for one hour, then wiped away. Heel prick blood sampling with a spring loaded lance was performed five minutes later. The procedure was videotaped and pain assessed at one second intervals using an adaptation of the neonatal facial coding system (NFCS). No or minimal pain was defined as a cumulative score of less than 5 (out of 15) in the three seconds after firing of the lance and as lack of a cry in the first five seconds.Results-In terms of a low NFCS core and lack of cry (p = 0.12) 20 of 30 (67%) in the amethocaine group and 13 of 29 (45%) in the placebo group had no or minimal pain in response to the heel prick. The median cumulative NFCS score over the three seconds after firing the lance was 3 (interquartile range 0-6) in the amethocaine group compared with 5 (interquartile range 1-10) in the placebo group (p = 0.07). These differences are not significant.Conclusions-Topical amethocaine gel does not have a clinically important effect on the pain of heel prick blood sampling and its use for this purpose cannot therefore be recommended. Alternative approaches to the relief of pain from this procedure should be explored.