• Paola Lago, Caterina Tiozzo, Giovanna Boccuzzo, Antonella Allegro, and Franco Zacchello.
• Department of Pediatrics, Neonatal Intensive Care, University of Padua, Padua, Italy. lago@pediatria.unipd.it
• Paediatr Anaesth. 2008 Aug 1;18(8):736-44.

BackgroundThere is limited evidence on the analgesic efficacy of opioids during percutaneous intravenous central catheter (PICC) insertion in preterm infants.AimTo assess the analgesic and procedural efficacy of low-dose remifentanil infusion during PICC in preterm infants.MethodsFifty-four neonates [mean gestational age (+/-sd) 28 +/- 2 weeks; birth weight 1126 +/- 337 g] were randomly assigned to remifentanil infusion at 0.03 mcg.kg(-1).min(-1) (R) or placebo (C) in addition to 0.3 ml of 12% sucrose per os and non-nutritive sucking.ResultsValidated pain scales [Neonatal Infants Pain Scale (NIPS) and Premature Infants Pain Profile (PIPP)] administered at the baseline T0, skin preparation T1, needle insertion T2, and recovery T3, revealed differences in mean NIPS scores (C 5.3 +/- 1.3 vs R 4.2 +/- 1.4 at T1 and C 5.0 +/- 1.3 vs R 3.4 +/- 1.3 at T2) and PIPP scores (C 9.3 +/- 1.6 vs R 7.1 +/- 1.5 at T1 and C 8.6 +/- 1.7 vs R 6.1 +/- 1.4 at T2); P < 0.05. Cardiovascular and respiratory response, and body movements during PICC suggested better pain and distress control with remifentanil (P < 0.05), but the time to complete the maneuver and the number of attempts needed remained the same in the two groups.ConclusionsLow-dose remifentanil has a measurable, synergic analgesic effect in combination with 12% sucrose and non-nutritive sucking, but does not make PICC easier or quicker.

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