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Pediatrics. 2017 Dec;140(6). pii: e20171935. doi: 10.1542/peds.2017-1935. Epub 2017 Nov 17.

Combination Analgesia for Neonatal Circumcision: A Randomized Controlled Trial.

Author information

1
Departments of Pediatrics and Adolescent Medicine and.
2
Surgery, American University of Beirut Medical Center, Beirut, Lebanon yelhout@aub.edu.lb.

Abstract

OBJECTIVES:

There is no consensus on the most effective pain management for neonatal circumcision. We sought to compare different modalities.

METHODS:

This is a double-blinded randomized controlled trial comparing 3 combination analgesics used during circumcision (EMLA + sucrose; EMLA + sucrose + dorsal penile nerve block [DPNB]; EMLA + sucrose + ring block [RB]) with the traditional topical analgesic cream EMLA alone. The trial was set in the normal nursery of a teaching hospital. The sample included 70 healthy male newborns, randomly assigned to intervention and control groups at a 2:1 ratio. Infants were videotaped (face and torso) during the procedure for assessment of pain by 2 blinded, independent reviewers. The primary outcome measure is the Neonatal Infant Pain Scale score. Secondary outcomes include heart rate, oxygen saturation, and crying time.

RESULTS:

Neonatal Infant Pain Scale scores were significantly lower in the intervention groups (EMLA + sucrose, mean [SD]: 3.1 [1.33]; EMLA + sucrose + DPNB: 3 [1.33]; EMLA + sucrose + RB: 2.45 [1.27]) compared with the control (5.5 [0.53]). Between-group analyses showed RB + EMLA + sucrose to be significantly more effective than EMLA + sucrose; EMLA + sucrose + DPNB (P = .009 and P = .002, respectively). Interrater reliability was κ = 0.843. Significant increase in heart rate (139.27 [9.63] to 163 [13.23] beats per minute) and crying time (5.78 [6.4] to 45.37 [12.39] seconds) were noted in the EMLA group.

CONCLUSIONS:

During neonatal circumcision in boys, the most effective analgesia is RB combined with oral sucrose and EMLA cream.

PMID:
29150457
DOI:
10.1542/peds.2017-1935
[Indexed for MEDLINE]
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