Original Approval: June 2009
Type: Guideline
Revised/Reviewed: 11/2010
Key Words: Oral Sucrose,
Sucrose Analgesia, 24%
Sucrose
To be reviewed: 11/2013
Supersedes: None
Nursing Services
I. Title:
Sucrose Analgesia: Guidelines for the Administration of 24% Sucrose Solution to
Infants
II. Purpose
To provide guidelines for the safe administration of 24% sucrose oral solution to provide
pain relief for infants.
III. Applicability
All UMHHC infants 25 weeks post conceptual age (PGA) up to six (6) months of age for
pain relief and comfort related to procedural, acute and ongoing pain.
.
IV. Definitions
Procedural pain indications for sucrose include but are not limited to
Nasogastric/Oral Gastric/Nasal insertion
Intramuscular or Subcutaneous injections
peripheral/central/arterial line placement
chest tube placement or removal
invasive line removal
arterial or venous puncture
endotracheal suctioning
suprapubic tap
Retinopathy of Prematurity exam
dorsal penile nerve block (circumcision)
heel sticks
tape removal
lumbar puncture
Continuous Positive Airway Pressure
removal of pacing wires
chest physiotherapy
suture placement or removal
Electrocardiogram
V. Procedures/Actions
A. Infants who are able to take sucrose orally or a pacifier coated with sucrose and
would benefit from the therapy are screened by the RN for contraindications and
precautions (see section for Contraindications and Precautions).
B. Twenty-four percent (24%) sucrose can be ordered by an RN and administered by an
RN, LPN, nursing intern/student, phlebotomist, medical assistant, respiratory
therapist or parent.
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Sucrose Analgesia: Guidelines for the Administration of 24% Sucrose Solution to Infants
C. Sucrose and non-nutritive sucking can also be used to provide comfort with the
management of acute and ongoing pain in infants.
D. For maximum effect, sucrose should be administered at least 2 minutes prior to a
painful procedure. When used for procedures, analgesic effect last approximately 5
minutes. Dose can be repeated every 2-3 minutes if needed. (Lefrak et al. 2006).
E. Sucrose can be given as an adjuvant non-pharmacological therapy to promote comfort
when an infant is experiencing acute pain or discomfort originating from other
unknown sources of discomfort.
F. Sucrose solution is not intended to be a substitute for appropriate analgesia. Use
additional analgesics as indicated by the anticipated painfulness of the procedure
and/or the infant’s response to the procedure.
G. Administer sucrose directly from single patient use vial to the anterior part of tongue
or coat pacifier with sucrose and offer to infant.
H. Offer pacifier as tolerated/desired to encourage non-nutritive sucking to promote
soothing and comfort.
I. Dosage Guidelines: administer in 1 gtt increments as needed/as tolerated.
Weight or Age
Suggested dose per event
<1000 gms:
1000-2000 gms:
>2000 gms:
Term infant and under 6 mos
0.05ml – 0.1 ml per event
0.05 ml – 0.2 ml per event
0.05-0.5 ml per event
0.05 ml -0.5 ml in increments up to 2 ml per event
See Exhibit A for recommended dosing and procurement of the current Sucrose
product
J. There is no maximum number of doses however the need for additional analgesic
intervention(s) should be assessed if more than 8-12 doses per day are administered.
K. Document each dose (gtts or number of pacifier dips) and infant’s response on the
patient care flow sheet.
L. Monitor the infant’s pain responses using appropriate pain assessment tool during and
after procedure, and ongoing.
M. Family education should include the differentiation between sucrose analgesia,
comfort and feeding.
N. Contraindications
1. Sucrose is contraindicated in the following:
a. Infants with active necrotizing enterocolitis (NEC).
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Sucrose Analgesia: Guidelines for the Administration of 24% Sucrose Solution to Infants
b. Infants in shock or with a recent history of low blood pressure/low perfusion
state; infants believed to have significantly diminished mesenteric perfusion.
2. Precautions with sucrose administration should be taken with the following
infants.
a. Those at risk for NEC and who are being treated for suspected NEC.
b. < 27 weeks PGA and those with cardiorespiratory instability (LeFrak, 2006).
c. Infants with esophageal atresia, tracheal esophageal fistula, or any other GI
surgical anomaly.
3. Literature has reported occasional transient desaturation with sucrose
administration; this may be related to the volume administered and methods of
administration. Use precaution in administering repeat doses if desaturation
occurs. Desaturation may be reduced by using minimal volume, and by
administering with a pacifier. (Lefrak, 2006).
VI. Exhibits
A.
B.
Dosage Guidelines
Parent Information Sheet, PDF, Information for Parents: Oral Sucrose for Infants
Having Painful Medical Procedures
VII. References
A.
References:
Harrison, D M, Oral sucrose for pain management in infants: Myths and
misconceptions. Journal of Neonatal Nursing, 2008; 39-46.
Harrison D, Stevens B, Bueno M, Ymada, J et al. Efficacy of sweet solutions for
analgesia in infants between 1 and 12 months of age: a systematic review. Arch
Dis Child 2010: 95:406-413.
Hatfiled L A, Gusic, M E, Dyer, A and Polomano, R C. Analgesic properties of
oral sucrose during routine immunizations at 2 and 4 months of age. Pediatrics
2008: 121e327-2334.
Lefrak l., Burch, K., et al. Sucrose analgesia: Identifying potentially better
practices, Pediatrics, 2006;118 (Supplement 2):197-202.
Mitchell A, Waltzman P. Oral sucrose and pain relief for preterm infants. Pain
Management Nursing, 2003: 4(2): 62-69.
Stevens B, Yamada J, Ohlsson A. Sucrose for analgesia in newborn infants
undergoing painful procedures. The Cochrane Database of Systemic Reviews
2004, Issue 3.
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Sucrose Analgesia: Guidelines for the Administration of 24% Sucrose Solution to Infants
Johnston CC, et al. Routine sucrose analgesia during the first week of life in
neonates younger than 31 weeks’ postconceptional age. Pediatrics. , 2002: 10(3):
523-528.
B.
Search Terms: Oral Sucrose, Sucrose Analgesia
VIII. Related Policies/Guidelines/Standards/Procedures
A. Anand KJS, et al. Consensus statement for the prevention and management of pain in the
newborn. Archives Pediatric Adolescent Medicine, 2001; 155:173-180.
IX. Author(s), Consultant(s)
A.
Authors:
Wendy Kenyon BSN, RN, Neonatal Intensive Care Unit, Holden
Jessie Antanaitis RN, Cardio-Thoracic Surgery Pediatrics
Denise Spicer BSN, RN-BC, Acute Care Pediatrics, 5W
Connie Ritter, AD, RN, Neonatal Intensive Care Unit, Holden
Mary Watson RN, BSN, MSBA, Clinical Project Manager, Ambulatory Care
Sandra Merkel MS, RN-BC, Clinical Nurse Specialist, Pediatric Acute Pain
Service
B.
Consultants
1. Pediatric Medical-Surgical Joint Practice Committee Approved/Endorsed
guideline June 19, 2009.
2. Pediatric Clinical Nurse Practice Network, October 14, 2010
X. Reviewed and Approved by:
Integrated Clinical Council, 11/2010
Nursing Executive Council, 12/2010
Original guideline documents are held by the Nursing Integrated Clinical Council. Direct questions to NurseICC_Administration@med.umich.edu.
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Sucrose Analgesia: Guidelines for the Administration of 24% Sucrose Solution to Infants
Exhibit A
Dosage Guidelines using Toot Sweet™ Twist-Tip vials
Administer 1 gtt at a time as needed and as tolerated
Weight or Age
Suggested dose per event
<1000 gms:
1000-2000 gms:
>2000 gms:
Term infant and under 6 mos
0.05ml – 0.1 ml per event (1-2 gtts)
0.05 ml – 0.2 ml per event (1-4 gtts)
0.05-0.5 ml per event 1-10 gtts)
0.05 ml -0.5 ml in increments up to 2 ml per event (2 vials)
1 ml vial = ~ 20 gtts
Each drop = ~ 40 ul (microliters)
To obtain Sucrose:
TootSweet (24% Sucrose)
Material Service Center (MSC)
Item # = 43844 Solution, Sucrose TootSweet 1 ml
Hawaii Medical
Manufacturer # = 333.1040027BX
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Sucrose Analgesia: Guidelines for the Administration of 24% Sucrose Solution to Infants
Exhibit B
“Information for Parents: Oral Sucrose for Infants Having Painful Medical Procedures”.
Parent/Caregiver handout can be downloaded and printed
http://www.med.umich.edu/i/nursing/policies/pediatrics/sucroseExB.pdf
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