AAOS 2016: Oral sucrose associated with decreased pain response during clubfoot casting

Study Type: Randomized Trial
OE Level of Evidence: N/A
Journal Level of Evidence: N/A
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Synopsis
33 children (131 castings) with idiopathic clubfoot were randomized to one of three treatments aiming to decrease neonatal pain response during Ponseti manipulation: (1) 20% oral sucrose solution, (2) bottled milk (breast/non-breast), or (3) water. The purpose of this study was to determine which treatment resulted in the greatest decrease in neonatal pain response, while additionally measuring heart rate and oxygen saturation before, during, and after-casting. Results demonstrated that Please login to view the rest of this report. Please login to view the rest of this report.
Why was this study needed now?
Manipulation and casting via the Ponseti method for the treatment of pediatric and idiopathic clubfoot often results in superior outcomes but has been reported to be difficult to perform due to an increased pain response in the infant during and immediately following the casting process. In response, there has been an increased interest in identifying a method of decreasing pain response, thus warranting the present study.
What was the principal research question?
In patients with congenital idiopathic clubfoot, how did either an oral 20% sucrose solution, water, or milk (breast/non-breast) effect neonatal pain response during manipulation and casting via the Ponseti technique?
Population: 33 children (mean age 17.94 days +/- 20.51 days) with congenital idiopathic clubfoot were included in this study. Each casting (performed via the Ponseti technique) was considered a separate event and was therefore randomized to one of the three treatments each time a casting was performed; each child received an average of 3.97 (+/-1.74) castings.
Intervention: Sucrose group: patients were given a 20% oral sucrose solution during manipulation and casting (n= 42 castings). Milk group: patients were given either breast or non-breast milk in a bottle during manipulation and casting (n= 37 castings).
Comparison: Water group: patients were given water during manipulation and casting (n= 39 castings).
Outcomes: Outcome measures included the neonatal infant pain scale (NIPS), heart rate, and oxygen saturation.
Methods: RCT: double-blinded
Time: Evaluations were made prior to casting, during cast, and after the casting was completed.
What were the important findings?
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What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.