Remifentanil for percutaneous intravenous central catheter placement in preterm infant: a randomized controlled trial

There is limited evidence on the analgesic efficacy of opioids during percutaneous intravenous central catheter (PICC) insertion in preterm infants.

To assess the analgesic and procedural efficacy of low-dose remifentanil infusion during PICC in preterm infants.

Fifty-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.

Validated 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.

Low-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.