Morphine and topical anesthesia found effective in treating pain in newborn infants

Intravenous morphine used alone or with topical tetracaine effectively reduced levels of pain in preterm newborn infants undergoing central line insertion procedures, according to a study in the February 15 issue of JAMA.

About 10 percent to 15 percent of newborns require prolonged hospitalization for conditions such as preterm birth, birth defects, and sepsis (a blood stream infection). As part of their medical care, they are often exposed to multiple invasive procedures that may be painful. There is accumulating evidence that untreated procedural pain in newborns leads to long-term changes in pain sensitivity, according to background information in the article. The effectiveness of local or systemic analgesics (pain relievers) to minimize pain in newborns during certain procedures is not clear.

Anna Taddio, Ph.D., of the Hospital for Sick Children and University of Toronto, and colleagues studied the relative efficacy and safety of topical local anesthesia (tetracaine) and intravenous opioid analgesia (morphine), used alone or in combination, for management of pain in newborns undergoing the insertion of a central venous catheter. The randomized, double-blind, controlled trial, conducted between October 2000 and July 2005, included 132 ventilated newborns (average gestational age, 30.6 weeks at study entry). Prior to catheter insertion, the newborns were randomly assigned to receive tetracaine (n = 42), morphine (n = 38), or both (n = 31); a separate nonrandomized group of 21 neonates receiving neither tetracaine nor morphine was used as a control group.

The researchers determined pain scores by measuring the proportion of time newborns displayed facial grimacing (brow bulge) during different phases of the procedure (skin preparation, needle puncture, and recovery).

The authors found that the combination of morphine (opioid analgesia) and tetracaine (local anesthesia) was more effective than either local anesthesia alone or no ana

Contact: Laura Greer
JAMA and Archives Journals

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