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

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). 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.