Table 8.

APA guidance for effective pharmacological and non-pharmacological techniques for pain management in neonates^*(9)

General guidance for neonates: (Grade of recommendation for the intervention)** Allow breastfeeding during procedures where possible (A) Non-nutritive sucking +/− sucrose for brief procedures (A)
Procedure	Recommended intervention in neonates (Grade of Recommendation**)
Blood sampling	Oral sucrose (A) Venepuncture in preference to heel lance (A) Topical LA effective for venepuncture (A) Sensory stimulation in combination with sucrose where possible (B) Topical LA alone insufficient for heel lance (A) Morphine alone insufficient for heel lance (B)
Lumbar Puncture	Topical LA (A)
Urine sampling	LA gel + catheterisation less painful than suprapubic aspiration with topical LA (B)
Ocular examination	LA eye drops (B) Pacifier (B) Sucrose (B)

GOOD PRACTICE POINT: Include pharmacological and non-pharmacological when possible IV – intravenous, LA - local anaesthetic

^*Association of Paediatric Anaesthetists of Great Britain and Ireland. Good practice in postoperative and procedural pain London, APA 2008 Available from: http://www.apagbi.org.uk/sites/apagbi.org.uk/files/APA%20Guideline%20part%201.pdf

^**Recommendations Graded A to D: based on levels of evidence graded I-IV. For full criteria see source paper* (9)