Sucrose solution for alleviating needle pain during inferior alveolar nerve block in children aged 7-10 years: a randomized clinical trial

  • Supriya Thambireddy (Department of Pediatric and Preventive Dentistry, Narayana Dental College and Hospital) ;
  • Nirmala SVSG (Department of Pediatric and Preventive Dentistry, Narayana Dental College and Hospital) ;
  • Sivakumar Nuvvula (Department of Pediatric and Preventive Dentistry, Narayana Dental College and Hospital)
  • 투고 : 2023.05.03
  • 심사 : 2023.09.12
  • 발행 : 2023.10.01


Background: Intraoral local anesthesia is essential for delivering dental care; however, injection of this local anesthetic is perceived as the most painful and distressing agent for children, parents, and healthcare providers. Reducing pain as much as possible is essential to ensure smooth subsequent treatment procedures, especially in pediatric dentistry. In clinical practice, oral sucrose administration has been reported to decrease the pain during heel lance and cold pressor tests in neonates and children. This study aimed to determine whether the prior administration of a 30% sucrose solution reduced the pain related to inferior alveolar nerve block in children. Methods: A total of 42 healthy children aged 7-10 years requiring dental treatment of mandibular molars involving inferior alveolar nerve block were recruited. The participants' demographic details were recorded, height and weight were measured, and the anesthetic injection was delivered after receiving the respective intraoral sucrose solution and distilled water by the intervention (group 1) and control (group 2) group participants for 2 min. The subjective pain perceived during injection was measured using an animated emoji scale. The pain scores between the groups were compared using the Mann-Whitney U test. Results: The median pain score and range for the intervention and control groups were 4 (2 - 6) and 6 (4 - 8), respectively, and statistically significant differences (P < 0.001) were observed in the intervention group. Age, sex, height, and weight did not influence the analgesic effect of the sucrose solution. Conclusion: Oral administration of sucrose may relieve pain associated with inferior alveolar nerve block in children.



  1. M M A, Khatri A, Kalra N, Tyagi R, Khandelwal D. Pain perception and efficacy of local analgesia using 2% lignocaine, buffered lignocaine, and 4% articaine in pediatric dental procedures. J Dent Anesth Pain Med 2019; 19: 101-9.
  2. Santhosh T, Balakrishnan RN, Malaiappan S. Comparative analysis of use of topical anesthetics and local anesthetic infiltrations among pediatric dental patients -a retrospective study research article. Int J Dent Oral Sci 2021; 8: 2906-10.
  3. Amrollahi N, Rastghalam N, Faghihian R. Effect of pre-cooling on pain associated with dental injections in children: a systematic review. J Evid Based Dent Pract 2021; 21: 101588.
  4. Johnson J, Primosch R. Influence of site preparation methods on the pain reported during palatal infiltration using the Wand Local Anesthetic System. Am J Dent 2003; 16: 165-9.
  5. Cepeda MS, Tzortzopoulou A, Thackrey M, Hudcova J, Arora Gandhi P, Schumann R. Adjusting the pH of lidocaine for reducing pain on injection. Cochrane Database Syst Rev 2010; (12): CD006581.
  6. Kurien RS, Goswami M. Comparative evaluation of anesthetic efficacy of warm, buffered and conventional 2% lignocaine for the success of inferior alveolar nerve block (IANB) in mandibular primary molars: a randomized controlled clinical trial. J Dent Res Dent Clin Dent Prospects 2018; 12: 102-9.
  7. Ghaderi F, Ghaderi R, Davarmanesh M, Bayani M, Arabzade Moghadam S. Pain management during needle insertion with low level laser. Eur J Paediatr Dent 2016; 17: 151-4.
  8. Leng HY, Zheng XL, Yan L, Zhang XH, He HY, Xiang M. Effects of different types and concentration of oral sweet solution on reducing neonatal pain during heel lance procedures. Zhonghua Er Ke Za Zhi 2013; 51: 654-8.
  9. Mysels DJ, Sullivan MA. The relationship between opioid and sugar intake: review of evidence and clinical applications. J Opioid Manag 2010; 6: 445-52.
  10. Kakeda T, Ogino Y, Moriya F, Saito S. Sweet taste-induced analgesia: an fMRI study. Neuroreport 2010; 21: 427-31.
  11. Bhattacharjee M, Mathur R. Antinociceptive effect of sucrose ingestion in the human. Indian J Physiol Pharmacol 2005; 49: 383-94.
  12. Stevens B, Yamada J, Lee GY, Ohlsson A. Sucrose for nalgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev 2016; 7: CD001069.
  13. Janiani P, Gurunathan D. Effectiveness of pre-administered natural sweet-tasting solution for decreasing pain associated with dental injections in children: a split-mouth randomized controlled trial. J Contemp Dent Pract 2021; 22: 1434-7.
  14. Ghaderi F, Ahmadbeigi M, Vossoughi M, Sardarian A. The efficacy of administrating a sweet-tasting solution for reducing the pain related to dental injections in children: A randomized controlled trial. Int J Paediatr Dent 2021; 31: 184-90.
  15. Schulz KF, Altman DG, Moher D; CONSORT Group. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med 2010; 8: 18.
  16. Khatri A, Kalra N, Tyagi R, Sharma M, Yangdol P, Garg N. Evaluation of pain in children using animated emoji scale: a novel self-reporting pain assessment tool. Int J Pedod Rehabil 2021; 6 :20-4.
  17. Piaget J. Piaget's theory of cognitive development. Childhood cognitive development: The essential readings. 2000; 2: 33-47
  18. Nuseir K, Kassab M, Al-Azzani M. Sweet solution analgesia. In: Pain Relief-From Analgesics to Alternative Therapies. 1st ed. Edited by Maldonado c, INTECH 2017: 301-13.
  19. Slater R, Cornelissen L, Fabrizi L, Patten D, Yoxen J, Worley A, Boyd S, Meek J, Fitzgerald M. Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial. Lancet 2010; 376: 1225-32.
  20. Shiiba SJ, Sakamoto E, Sago T, Furuta H, Yamamoto T, Tada Y, et al. Effect of sweet solutions on pain tolerance threshold in pediatric oral mucosa. Pediatr Dent J 2012; 22: 22-6.
  21. Kaufman E, Epstein JB, Naveh E, Gorsky M, Gross A, Cohen G. A survey of pain, pressure, and discomfort induced by commonly used oral local anesthesia injections. Anesth Prog 2005; 52: 122-7.[122:ASP]2.0.CO;2
  22. Lewkowski MD, Barr RG, Sherrard A, Lessard J, Harris AR, Young SN. Effects of chewing gum on responses to routine painful procedures in children. Physiol Behav 2003; 79: 257-65.
  23. Lee J, Russell CG, Mohebbi M, Keast R. Grating orientation task: a screening tool for determination of oral tactile acuity in children. Food Qual Prefer 2022; 95: 104365.
  24. Kostecka M, Kostecka-Jarecka J, Kowal M, Jackowska I. Dietary habits and choices of 4-to-6-year-olds: do children have a preference for sweet taste? Children 2021; 8: 774.
  25. Pepino YM, Mennella JA. Sucrose-induced analgesia is related to sweet preferences in children but not adults. Pain 2005; 119: 210-8.
  26. Mennella JA, Pepino MY, Lehmann-Castor SM, Yourshaw LM. Sweet preferences and analgesia during childhood: effects of family history of alcoholism and depression. Addiction 2010; 105: 666-75.