Pre-emptive Penile Ring Block With Sucrose Analgesia Reduces Pain Response to Neonatal Circumcision

Roman-Rodriguez, Christian F.; Toussaint, Thomas; Sherlock, Douglas; Fogel, Joshua; Hsu, Chaur‐Dong

doi:10.1016/j.urology.2013.10.010

Cited by 5 publications

(12 citation statements)

References 13 publications

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“…Seventeen articles compared the effect of different analgesic methods in newborns' MC [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] while 4 articles compared the effects of different surgical techniques on pain levels [35][36][37][38]. Thirteen studies enrolled more than 20 patients for each study group [17,18,20,21,23,24,[27][28][29][30][31][32][33].…”

Section: Resultsmentioning

confidence: 99%

“…The main pharmacological methods used in the retrieved trials were as follows: EMLA cream which is an eutectic mixture of local anesthetics, with 2.5% lidocaine and 2.5% prilocaine producing dermal analgesia when applied as a topical cream on the skin 60-90 minutes before the procedure [5,22,26,31,32]; dorsal penile nerve block (DPNB) which involves regional anesthesia often obtained with 0.4 ml of 1% lidocaine or with bupivacaine injected at the base of the penis at the 10:00 and 2:00 positions [5,17,21,[23][24][25]; subcutaneous penile ring block (RB) which consists of the injection of 0.8 ml of 1% lidocaine in a circumferential ring around either the midshaft or at the level of the corona [5,30,32].…”

Section: Resultsmentioning

confidence: 99%

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Management of pain in newborn circumcision: a systematic review

2020

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Male circumcision (MC) is one of the most common surgical procedures performed on neonates. In the last decades, there have been consistent advances in the understanding of pain mechanisms in newborns, and analgesia has become a fundamental part of neonatal care. MC is still often performed with inappropriate analgesic methods, and there is still great variability among the various centers about surgical and anesthethic techniques to do it. The purpose of this review is to summarize the findings in the literature about pain management and analgesia during newborn MC. We performed a systematic review of neonatal MC studies published in the last 20 years. The most effective technique appeared to be the combination of pharmacological and non-pharmacological methods of analgesia.Conclusion: Combining local anesthesia with non-pharmacological analgesic strategies appears to be effective preventing procedural pain during MC. However, a standardized protocol for analgesia during MC is yet to be determined. Sensorial saturation appeared to help when used in conjunction with the local anesthesia techniques. What is Known:• Male circumcision is a painful procedure and it is frequently performed with inappropriate analgesic methods.• A gold standard practice in analgesia during male circumcision is still lacking and there is a great variability in the modus operandi between centers. What is New:• The combination of RB + EMLA + sucrose appears to be an analgesic strategy superior to other approaches.• We advocate for the integration of sensorial saturation during male circumcision in order to improve the efficacy of current analgesic practices.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Management of pain in newborn circumcision: a systematic review

2020

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“…Acetaminophen is one of the most commonly used systemic medications in the neonatal population due to its well-established effectiveness at pain reduction as well as its favorable side effect profile. Acetaminophen is recommended for use in mildly to moderately painful procedures such as heelsticks, fingersticks, adhesive removal, dressing changes, wound treatment, venipuncture, arterial puncture, and circumcision [ 1 , 51 , 52 , 55 , 56 ]. There are various formulations, which have different dosing and clearance patterns, particularly in neonates.…”

Section: Tier 2–5: Pharmacologic Managementmentioning

confidence: 99%

“…As noted with other measures, the use of lidocaine injections is most effective when used in combination with other interventions. For optimal pain relief with circumcision, sucrose use throughout the procedure and acetaminophen use for post-procedural pain was most effective [ 55 ]. In neonates, the recommended dose is 0.5 % (5 mg/mL) or 1 % (10 mg/mL) solution to a maximum dose of 3–5 mg/kg [ 55 ].…”

Section: Tier 2–5: Pharmacologic Managementmentioning

confidence: 99%

“…For optimal pain relief with circumcision, sucrose use throughout the procedure and acetaminophen use for post-procedural pain was most effective [ 55 ]. In neonates, the recommended dose is 0.5 % (5 mg/mL) or 1 % (10 mg/mL) solution to a maximum dose of 3–5 mg/kg [ 55 ]. Again, as with EMLA, in higher doses, there is risk of arrhythmia and seizures when approaching toxic doses.…”

Section: Tier 2–5: Pharmacologic Managementmentioning

confidence: 99%

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A Guide to Pain Assessment and Management in the Neonate

Witt

Coynor

Edwards

et al. 2016

Curr Emerg Hosp Med Rep

192

134

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Newborn infants experience acute pain with various medical procedures. Evidence demonstrates that controlling pain in the newborn period is beneficial, improving physiologic, behavioral, and hormonal outcomes. Multiple validated scoring systems exist to assess pain in a neonate; however, there is no standardized or universal approach for pain management. Healthcare facilities should establish a neonatal pain control program. The first step is to minimize the total number of painful iatrogenic events when possible. If a procedure cannot be avoided, a tiered approach to manage pain using environmental, non-pharmacologic, and pharmacologic modalities is recommended. This systematic approach should decrease acute neonatal pain, poor outcomes, and provider and parent dissatisfaction.

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Avoidance of general anesthesia for circumcision in infants under 6 months of age using a modified Plastibell technique

et al. 2019

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Purpose There is currently no gold standard for the type of analgesia or preferred circumcision technique in infants requiring circumcision after 1 month of age. Our study presents a modified Plastibell circumcision technique, which offers excellent surgical outcomes, and can be performed under local anesthesia until 6 months of age, thereby avoiding the risks of general anesthesia in delayed circumcision. Methods This is a retrospective case series of 508 consecutive male infants between 1 and 6 months of age, from one institution, who all underwent circumcision under local anesthesia, performed by the same pediatric surgeon, from 2013 to 2018. The study parameters included postoperative complications such as re-operation for control of hemorrhage, wound infection, circumcision revision, and urethral meatotomy. Results There were no re-operations for control of hemorrhage, no wound infections, and no circumcision revisions. One patient developed urethral meatal stenosis requiring urethral meatotomy. Conclusion Our modified Plastibell circumcision technique under local anesthesia is a safe and reproducible alternative for infants between 1 and 6 months of age, whose parents desire circumcision and wish to avoid general anesthesia.

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Pre-emptive Penile Ring Block With Sucrose Analgesia Reduces Pain Response to Neonatal Circumcision

Cited by 5 publications

References 13 publications

Management of pain in newborn circumcision: a systematic review

Management of pain in newborn circumcision: a systematic review

A Guide to Pain Assessment and Management in the Neonate

Avoidance of general anesthesia for circumcision in infants under 6 months of age using a modified Plastibell technique

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