Avaliação da analgesia com o uso da mistura eutética de anestésico local (lidocaína e prilocaína) e/ou solução oral de glicose a 25% em recém-nascidos pré-termo durante instalação de cateter central de inserção periférica

Abstract

Objective: the aim of this study was to compare the use of eutetic misture of local anesthetic (EMLA®) and oral glucose solution 25% or both for pain control in preterm neonates during installation of peripherally inserted central catheter (PICC). Método: triple-masked, randomized, controlled trial. Were studied thirty preterm neonates (gestational age between 28 to 36 weeks) admitted at the Neonatal Division of the Clinics Hospital of the Federal University of Minas Gerais, in Belo Horizonte, Brazil and Neonatal Division of Julia Kubitschek Hospital, from February 2009 to March 2010. The infants were randomized in three treatment groups: EMLA® plus glucose 25% (n=9); EMLA® plus placebo (bidestilated water) (n=9) and glucose 25% plus placebo cream (n=12). Six observational periods were considered during the procedure and pain-related responses to PICC were evaluated using the Neonatal Infant Pain Scale (NIPS), heart rate, peripheral oxygen saturation of hemoglobin, arterial pressure and cry. Results: there was no significant statistical difference between the three groups considering the primary outcome (a difference of two points in the NIPS score), the same for heart rate, arterial pressure and peripheral oxygen saturation. Significant differences in pain scores were detected when the patients were evaluated in different observational periods. The puncture and progress periods had higher pain scores compared with basal period. Conclusion: a difference of two points or more in the NIPS score can not be identified by using EMLA® cream, glucose of both therapies together. Furthermore none of these treatments were efficient in reducing pain during PICC insertion.