Anesthesia Management: Pre-emptive penile ring block with sucrose analgesia reduces pain response to neonatal circumcision

Published in Urology. 2014 Apr;83(4):893-8

Authors: Roman-Rodriguez CF et al., 

OBJECTIVE:

To compare retrospective use of oral sucrose (SUC) vs oral sucrose plus lidocaine ring block (SUC + RB) in the management of pain during neonatal circumcision.

METHODS:

A retrospective review of medical records of newborns circumcised using the “Neonatal Infant Pain Scale” was done.

RESULTS:

With regard to pain, the SUC group had a significantly greater percentage of those with pain than the SUC + RB group at 1 minute (77.7% vs 69.4%; P = .01) and 5 minutes (65.7% vs 55.7%; P = .004). There was no significant pain difference at 30 minutes. In the multivariate logistic regression analyses, those in the SUC group had significantly greater odds for pain at 1 minute than those in the SUC + RB group (odds ratio 1.45, 95% confidence interval 1.04-2.02; P = .03). No significant difference was noted at 5 minutes. Each of the SUC and SUC + RB groups had significant decreases in pain percentages at 5 minutes and 30 minutes (P less than .001). In addition, post-term gestational age had significantly greater odds for pain at 5 minutes (odds ratio 3.67, 95% confidence interval 1.51-8.93; P = .004).

CONCLUSION:

We found that sucrose use alone as compared with sucrose and ring block combined had greater odds for pain at 1 minute but not at 5 minutes. In addition, those with post-term gestational age had greater odds for pain at 5 minutes as compared with those with regular gestational age. We recommend for hospital-based circumcision using clamps, the use of combined sucrose and ring block for increased analgesia. In addition, for post-term neonates, we recommend greater focus on pain levels, including considering higher dosages of pain medications.