title: Pre-emptive penile ring block with sucrose analgesia reduces pain response to neonatal circumcision.
abstract: 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 <.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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynecology, Nassau University Medical Center, East Meadow, NY. Electronic address: croman@numc.edu.
authors.forename: Christian F
authors.initials: CF
authors.lastname: Roman-Rodriguez
authors.affiliation: Department of Obstetrics and Gynecology, Nassau University Medical Center, East Meadow, NY.
authors.forename: Thomas
authors.initials: T
authors.lastname: Toussaint
authors.affiliation: Department of Obstetrics and Gynecology, Nassau University Medical Center, East Meadow, NY.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Sherlock
authors.affiliation: Department of Finance and Business Management, Brooklyn College, Brooklyn, NY.
authors.forename: Joshua
authors.initials: J
authors.lastname: Fogel
authors.affiliation: Department of Obstetrics and Gynecology, Nassau University Medical Center, East Meadow, NY.
authors.forename: Chaur-Dong
authors.initials: CD
authors.lastname: Hsu
mesh_terms: D000698:Analgesia / Q000379:methods*; D002944:Circumcision, Male / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D008012:Lidocaine / Q000008:administration & dosage*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010146:Pain; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010413:Penis / Q000601:surgery*; D012189:Retrospective Studies; D013395:Sucrose / Q000008:administration & dosage*; D013525:Surgical Instruments; D013997:Time Factors
chemical_list: D013395:Sucrose; D008012:Lidocaine