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Neonatal Infant Pain Scale in assessing pain and pain relief for newborn male circumcision
1Department of Pediatrics, University of Siena, Viale M Bracci 36, 53100, Siena, Italy. bellieni@unisi.it.
Insights
Neonatal circumcision is painful, and current pain relief methods are insufficient. Most newborns experience clinically significant pain, indicating a need for improved pain management strategies during the procedure.
Area of Science:
- Pediatric Surgery
- Neonatal Pain Management
- Evidence-Based Medicine
Background:
- Neonatal circumcision involves cutting sensitive genital tissue, making it inherently painful.
- Effective pain management is crucial for infant well-being during this procedure.
Purpose of the Study:
- To review evidence on newborn pain during circumcision.
- To assess the efficacy of current analgesic methods in eliminating this pain.
Main Methods:
- Systematic search of medical databases for trials on neonatal circumcision pain published in the last 20 years.
- Selection of trials using validated pain scales, specifically the modified Neonatal Infant Pain Scale (mNIPS).
- Analysis of comparable data from selected trials.
Main Results:
- Twenty-three trials were reviewed, with most using the mNIPS (0-6 scale).
- No analgesic strategy completely eliminated pain during neonatal circumcision.
- Most pain assessments exceeded a score of 3, indicating clinically significant pain.
Conclusions:
- Current analgesic methods do not eliminate pain in neonatal circumcision.
- Newborns consistently experience significant pain, necessitating advancements in pain control.
- Further research is needed to develop more effective pain management strategies.
Abstract:
Circumcision-partial or total removal of the penile prepuce-requires cutting nerve-laden, sensitive genital tissue and is therefore liable to be painful. The aim of this review is to evaluate the evidence concerning pain felt by newborns during circumcision and to determine whether current analgesic methods can eliminate such pain. I performed a search in medical databases, selecting the trials published in the last 20 years that assessed pain in neonatal circumcision. Twenty-three trials have been retrieved. To get reliable findings, those trials that used validated pain scales were selected; then it was investigated which trials had comparable data for using the same pain scale. The only pain scale that was used in more than two trials was the modified Neonatal Infant Pain Scale (mNIPS) that ranges 0-6. The results of these trials show that none of the analgesic strategies used obtained the absence of pain. Some differences between circumcision techniques can be noticed, but most assessments exceed the score of 3, chosen as the clinically significant pain.
