Good Practice in Postoperative and Procedural Pain Management ...

increased success rate (i.e., less red cell contamination).Analgesia Table 4.2.3 Lumbar puncture in the neonateDirectevidenceIndirectevidenceLocal anesthesia Topical 1+Infiltration a 1+Sucrose 1++Non-nutritive sucking 1+Nonpharmacological 1+Procedure Modification 2+Analgesia Table 4.2.4 Urine sampling in the neonateDirectevidenceIndirectevidence1+Local anesthesia Topicallubricant gel aSucrose 1) 1++Non-nutritive sucking 1+Nonpharmacological 1+Procedure modification a 1+a Urethral catheterization.a Older children and adults.4.2.4 Urine sampling in the neonateUrine sampling can be important to detect urinarytract infection in neonates and must be collectedavoiding sample contamination. Direct catheterizationof the urethra or catheterization of the bladderby the percutaneous suprapubic route is often preferredbecause some types of urine collection bagshave a high rate of contamination, and ‘clean catch’specimens can be difficult or time-consuming to collect.RecommendationsTransurethral catheterization with local anesthetic gel ispreferred as it is less painful than suprapubic catheterizationwith topical local anesthesia: Grade B (72,73).Sucrose reduces the pain response to urethral catheterization:Grade C (74).EvidencePain responses were observed in neonates and infantshaving either urethral or suprapubic catheterizationwith local anesthesia (72). Transurethral catheterizationappeared to be less painful (72). Sucrose analgesiaimmediately before bladder catheterization in neonatesand infants up to 3 months old was not effective atabolishing pain responses; however, a reduction inresponse was observed in the subgroup of those