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NEONATOLOGY

Efficacy of Topical Anesthetics to Reduce Pain in Premature Infants During Eye Examinations for Retinopathy of Prematurity

Staff Nurse, Nursing Department, Neonatal Intensive Care Unit, Women's Hospital, Greensboro, NC

William O Young, MD

Consulting Ophthalmologist, Neonatal Intensive Care Unit, Women's Hospital, Greensboro; Pediatric Ophthalmology Associates PA, Greensboro

Kimberly K Dunaway, PharmD

Staff Pharmacist, Pharmacy Department, Women's Hospital

Grace E Kissling, PhD

Staff Scientist, Biostatistics Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC

Rita Q Carlos, MD

Neonatologist, Neonatal Intensive Care Unit, Women's Hospital

Susan M Jones, RNC BSN

Staff Nurse, Nursing Department, Neonatal Intensive Care Unit, Women's Hospital

Dawn H Shockley, RN BS ADN

Staff Nurse, Nursing Department, Neonatal Intensive Care Unit, Women's Hospital

Nicole L Weaver, BSN

Staff Nurse, Nursing Department, Neonatal Intensive Care Unit, Women's Hospital

J Laurence Ransom, MD

Medical Director, Neonatal Intensive Care Unit, Women's Hospital; Clinical Professor, Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC

Peter Gal, PharmD BCPS FCCP FASHP

Director, Pharmacy Division, Greensboro Area Health Education Center; Clinical Professor, School of Pharmacy, University of North Carolina at Chapel Hill; Pharmacotherapy Specialist, Department of Neonatology, Women's Hospital

Reprints: Dr. Gal, Greensboro AHEC, Ste. 100, 200 E. Northwood St., Greensboro, NC 27401-1020, fax 336/832-7851, peter.gal{at}mosescone.com

BACKGROUND: Eye examinations for retinopathy of prematurity (ROP) are stressful and probably painful, but many ophthalmologists do not apply topical anesthetics because their efficacy in reducing pain has not been established.

OBJECTIVE: To evaluate the potential benefits of topical anesthetic eye drops in reducing pain during neonatal eye examination for ROP.

METHODS: Neonates born at 30 weeks' gestation and expected to have at least 2 examinations for ROP were included. Patients were randomly assigned to receive either proparacaine HCl ophthalmic solution 0.5% or NaCl 0.9% (saline) eye drops prior to an eye examination. In a subsequent examination, each patient received the alternate treatment. Eye drops were prepared in the pharmacy in identical tuberculin syringes, and physicians, nurses, and pharmacists were blinded to the treatment given. Pain was measured using a scoring system with both physical and physiologic measures of pain (Premature Infant Pain Profile [PIPP], possible range 1-21), which has been validated in preterm infants. PIPP scoring was performed simultaneously by 2 nurses: 1 and 5 minutes before and after the eye examination and during initial placement of the eye speculum. The same ophthalmologist performed all examinations.

RESULTS: Twenty-two patients were studied, with 11 infants receiving proparacaine and 11 receiving saline as the first treatment. Crossover was performed with a median of 17.5 days between treatments. Patients experienced significantly less pain at speculum insertion with proparacaine than with saline (paired difference -2.5 ± 3.4; p = 0.001).

CONCLUSIONS: Topical anesthetic pretreatment reduces the pain response to eye examination for ROP and should become routine practice. Because this is not effective in all infants, additional measures to reduce pain should be taken.

Key Words: proparacaine, retinopathy of prematurity

Published Online, March 29, 2005. www.theannals.com, DOI 10.1345/aph.1E476

This article has been cited by other articles:

				American Academy of Pediatrics, Committee on Fetus and Newborn and Section on Surg, Canadian Paediatric Society, and Fetus and Newborn Committee Prevention and Management of Pain in the Neonate: An Update Pediatrics, November 1, 2006; 118(5): 2231 - 2241. [Abstract] [Full Text] [PDF]

				P. Gal, G. E Kissling, W. O Young, K. K Dunaway, V. A Marsh, S. M Jones, D. H Shockley, N. L Weaver, R. Q Carlos, and J L. Ransom Efficacy of Sucrose to Reduce Pain in Premature Infants During Eye Examinations for Retinopathy of Prematurity Ann. Pharmacother., June 1, 2005; 39(6): 1029 - 1033. [Abstract] [Full Text] [PDF]