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Archives of Disease in Childhood. Fetal and Neonatal Edition logoLink to Archives of Disease in Childhood. Fetal and Neonatal Edition
. 1998 Nov;79(3):F209–F211. doi: 10.1136/fn.79.3.f209

Randomised controlled trial of paracetamol for heel prick pain in neonates

V Shah, A Taddio, A Ohlsson
PMCID: PMC1720857  PMID: 10194994

Abstract

AIM—To evaluate the effectiveness of paracetamol in decreasing the pain from heel prick.
METHODS—A prospective randomised double blind placebo controlled trial was conducted of 75 term neonates undergoing heel prick. Sixty to 90 minutes before the procedure neonates received paracetamol orally in a dose of 20 mg/kg (group 1) or an equal volume of placebo (group 2). Heel prick was performed in a standardised manner. Pain assessments were made using per cent facial action (brow bulge, eye squeeze, and nasolabial fold (range 0-300%) and per cent of time spent crying (range 0-100%).
RESULTS—Thirty eight neonates were enrolled in group 1 and 37 neonates in group 2. There were no significant differences in the demographic characteristics between groups. Mean gestational age was 39 (SD 1.4) vs 39.4 (SD 1.2) weeks, p=0.86, mean birthweight 3.45 (SD 0.45) vs 3.44 (SD 0.42) kg; p=0.31 for groups 1 and 2, respectively. Facial action pain scores did not differ between groups (143.5(SD 54.2)% vs 131.1 (SD 59.6)%; p=0.38). Cry scores also did not differ (29.4 (SD 19.9)% vs 26.8 (SD 20.2)%; p=0.60). No adverse effects were observed.
CONCLUSION—Paracetamol is ineffective for decreasing the pain from heel prick in term neonates.



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Selected References

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  1. Campos R. G. Rocking and pacifiers: two comforting interventions for heelstick pain. Res Nurs Health. 1994 Oct;17(5):321–331. doi: 10.1002/nur.4770170503. [DOI] [PubMed] [Google Scholar]
  2. Craig K. D., Whitfield M. F., Grunau R. V., Linton J., Hadjistavropoulos H. D. Pain in the preterm neonate: behavioural and physiological indices. Pain. 1993 Mar;52(3):287–299. doi: 10.1016/0304-3959(93)90162-I. [DOI] [PubMed] [Google Scholar]
  3. Field T., Goldson E. Pacifying effects of nonnutritive sucking on term and preterm neonates during heelstick procedures. Pediatrics. 1984 Dec;74(6):1012–1015. [PubMed] [Google Scholar]
  4. Franck L. S. A new method to quantitatively describe pain behavior in infants. Nurs Res. 1986 Jan-Feb;35(1):28–31. [PubMed] [Google Scholar]
  5. Grunau R. V., Craig K. D. Pain expression in neonates: facial action and cry. Pain. 1987 Mar;28(3):395–410. doi: 10.1016/0304-3959(87)90073-X. [DOI] [PubMed] [Google Scholar]
  6. Grunau R. V., Craig K. D. Pain expression in neonates: facial action and cry. Pain. 1987 Mar;28(3):395–410. doi: 10.1016/0304-3959(87)90073-X. [DOI] [PubMed] [Google Scholar]
  7. Harpin V. A., Rutter N. Making heel pricks less painful. Arch Dis Child. 1983 Mar;58(3):226–228. doi: 10.1136/adc.58.3.226. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Hopkins C. S., Underhill S., Booker P. D. Pharmacokinetics of paracetamol after cardiac surgery. Arch Dis Child. 1990 Sep;65(9):971–976. doi: 10.1136/adc.65.9.971. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Howard C. R., Howard F. M., Weitzman M. L. Acetaminophen analgesia in neonatal circumcision: the effect on pain. Pediatrics. 1994 Apr;93(4):641–646. [PubMed] [Google Scholar]
  10. Jackson C. H., MacDonald N. C., Cornett J. W. Acetaminophen: a practical pharmacologic overview. Can Med Assoc J. 1984 Jul 1;131(1):25-32, 37. [PMC free article] [PubMed] [Google Scholar]
  11. Johnston C. C., Strada M. E. Acute pain response in infants: a multidimensional description. Pain. 1986 Mar;24(3):373–382. doi: 10.1016/0304-3959(86)90123-5. [DOI] [PubMed] [Google Scholar]
  12. Larsson B. A., Jylli L., Lagercrantz H., Olsson G. L. Does a local anaesthetic cream (EMLA) alleviate pain from heel-lancing in neonates? Acta Anaesthesiol Scand. 1995 Nov;39(8):1028–1031. doi: 10.1111/j.1399-6576.1995.tb04223.x. [DOI] [PubMed] [Google Scholar]
  13. Miller R. P., Roberts R. J., Fischer L. J. Acetaminophen elimination kinetics in neonates, children, and adults. Clin Pharmacol Ther. 1976 Mar;19(3):284–294. doi: 10.1002/cpt1976193284. [DOI] [PubMed] [Google Scholar]
  14. Owens M. E., Todt E. H. Pain in infancy: neonatal reaction to a heel lance. Pain. 1984 Sep;20(1):77–86. doi: 10.1016/0304-3959(84)90813-3. [DOI] [PubMed] [Google Scholar]
  15. Piletta P., Porchet H. C., Dayer P. Central analgesic effect of acetaminophen but not of aspirin. Clin Pharmacol Ther. 1991 Apr;49(4):350–354. doi: 10.1038/clpt.1991.40. [DOI] [PubMed] [Google Scholar]
  16. Ramenghi L. A., Griffith G. C., Wood C. M., Levene M. I. Effect of non-sucrose sweet tasting solution on neonatal heel prick responses. Arch Dis Child Fetal Neonatal Ed. 1996 Mar;74(2):F129–F131. doi: 10.1136/fn.74.2.f129. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Rushforth J. A., Griffiths G., Thorpe H., Levene M. I. Can topical lignocaine reduce behavioural response to heel prick? Arch Dis Child Fetal Neonatal Ed. 1995 Jan;72(1):F49–F51. doi: 10.1136/fn.72.1.f49. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Skogsdal Y., Eriksson M., Schollin J. Analgesia in newborns given oral glucose. Acta Paediatr. 1997 Feb;86(2):217–220. doi: 10.1111/j.1651-2227.1997.tb08872.x. [DOI] [PubMed] [Google Scholar]
  19. Stevens B., Taddio A., Ohlsson A., Einarson T. The efficacy of sucrose for relieving procedural pain in neonates--a systematic review and meta-analysis. Acta Paediatr. 1997 Aug;86(8):837–842. doi: 10.1111/j.1651-2227.1997.tb08607.x. [DOI] [PubMed] [Google Scholar]
  20. Taddio A., Goldbach M., Ipp M., Stevens B., Koren G. Effect of neonatal circumcision on pain responses during vaccination in boys. Lancet. 1995 Feb 4;345(8945):291–292. doi: 10.1016/s0140-6736(95)90278-3. [DOI] [PubMed] [Google Scholar]
  21. Taddio A., Katz J., Ilersich A. L., Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet. 1997 Mar 1;349(9052):599–603. doi: 10.1016/S0140-6736(96)10316-0. [DOI] [PubMed] [Google Scholar]

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