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

Background: There is limited evidence on the analgesic efficacy of opioids during percutaneous intravenous central catheter (PICC) insertion in preterm infants. Aim: To assess the analgesic and procedural efficacy of low-dose remifentanil infusion during PICC in preterm infants. Methods: 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. Results: 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. Conclusions: 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.