Comparison of the effectiveness of oral sucrose solution and topical anaesthetics during immunization in infants between age 6 weeks-6 months

Ashwani Kumar, Gursharan Singh Narang, Gurmeet Singh, Jaskeen Kaur


Background: Routine childhood immunization is a proven tool for eradicating and controlling infectious diseases. Despite its key role in maintaining global public health, many individuals either refuse or delay immunization because of pain from the needle puncture. Several methods have been employed to reduce injection pain during immunization in children.

Methods: Study comprised of 210 healthy infants coming for immunizations. They were divided into three groups A, B and C having equal number of infants. Group A was given oral sucrose solution, group B was given topical anaesthetic prior to immunization; whereas group C acted as controls. Response to pain was recorded among the three groups and findings were analyzed.

Results: Infants enrolled in group A, i.e. those who were given 24% oral sucrose solution before immunization showed significant reduction in pain (measured by modified behaviour pain scale) as compared to control group at 15 seconds and 60 seconds of injection administration. Infants enrolled in group B, i.e. those who were sprayed topical local anaesthetics (10% lignocaine spray) before immunization showed significant reduction in pain as compared to control group at 15 seconds and 60 seconds of injection administration.

Conclusions: Administration of oral sucrose solution and application of topical local anaesthetics are effective measures to reduce injection pain during immunization. Administration of oral sucrose solution before immunization showed greater reduction in pain as compared to application of topical local anaesthetics in present study.


Immunization, Oral sucrose solution, Topical local anaesthetics

Full Text:



Centers for Disease Control and Prevention. Recommended immunization schedule for persons 0 through 18 years. Atlanta, GA: Centers for Disease Control and Prevention; Available at: /schedules /hcp/imz/ child-dolescent.html.

Shah V, Taddio A, McMurtry CM. Pharmacological and combined interventions to reduce vaccine injection pain: systematic review of randomized controlled trials and quasi-randomized controlled trials. Clin J Pain. 2015;31(10).

Taddio A, Chambers C, Halperin S, Ipp M, Lockett D, Rieder MJ, et al. Inadequate pain management during childhood immunization: the nerve of it. Clin Ther. 2009;31:S152-67.

Schechter NL, Zempsky WT, Cohen LL, Patrick J. Pain reduction during pediatric immunizations: Evidence based review and recommendations. Pediatr. 2007;119(5):25-32.

Jain A, Rutter N. Local anesthetic effect of topical amethocaine gel in neonates: randomized controlled trial. Arch Dis Child Fetal Neonatal. 2000;82:42-5.

Houck CS. Anesthetic agents- actions and toxicity. In: Holbrook PR, ed. Textbook of pediatric critical care. Philadelphia: WB Saunders; 1993:967-970.

Omer SB, Salmon DA, Orenstein WA, DeHart P, Halsey N. Vaccine refusal, mandatory immunization, and the risks of vaccine preventable diseases. New Engl J Med. 2009;360:1981-8.

Gibbins S, Stevens B. Mechanisms of sucrose and non-nutritive sucking in procedural pain management in infants. Pain Res Manag. 2001;6(1):21-8.

Kundu S, Achar S. Principles of office anesthesia: part II. Topical anesthesia. Am Fam Physician. 2002;66(1):99-102.

Hatfield LA, Gusic ME, Dyer AM. Analgesic properties of oral sucrose during routine immunizations at 2 and 4 months of age. Pediatr. 2008;121:327-34.

Hatfield LA. Sucrose decreases infant biobehavioral pain response to immunizations: a randomized controlled trial. J Nurs Scholarsh. 2008;40:219-25.

Yilmaz G, Caylan N, Oguz M. Oral sucrose administration to reduce pain response during immunization in 16-19-month infants: a randomized, placebo-controlled trial. Eur J Pediatr. 2014;173(11):1527-32.

Lewindon PJ, Harkness L, Lewindon N. Randomised controlled trial of sucrose by mouth for the relief of infant crying after immunisation. Arch Dis Childhood. 1998;78(5):453-6.

Allen KD. Sucrose as an analgesic agent for infants during immunization injections. Arch Pediatr Adolesc Med. 1996;150(3):270-4.

Wilson S, Bremner AP, Mathews J, Pearson D. The use of oral sucrose for procedural pain relief in infants up to six months of age: a randomized controlled trial. Pain Management Nursing. 2013;14(4):e95-105.

Curry DM. Effectiveness of oral sucrose for pain management in infants during immunizations. Pain Manag Nurs. 2012;13(3):139-49.

Taddio A, Nulman I, Goldbach M. Use of lidocaine-prilocaine cream for vaccination pain in infants. J Pediatr. 1994;124:643-8.

O’Brien L, Taddio A, Ipp M, Goldbach M, Koren G. Topical 4% amethocaine gel reduces the pain of subcutaneous measles-mumps-rubella vaccination. Pediatrics. 2004;114(6):e720-4.

Halperin SA, McGrath P, Smith B, Houston T. Lidocaine-prilocaine patch decreases the pain associated with the subcutaneous administration of measles-mumps-rubella vaccine but does not adversely affect the antibody response. J Pediatr. 2000;136:789-94.