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Analgesia and Pain Management

Analgesia and Pain Management

Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...

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Improving pain score and restraint duration during circumcision.

Ramzi A Kilani¹

¹Department of Pediatrics and Family Practice, University of Illinois at Chicago (UIC), Peoria, Illinois, USA.

Journal of Family Medicine and Primary Care

|May 21, 2025

Summary

A quality improvement project successfully reduced pain and restraint during circumcision by implementing a ring block policy and eliminating topical EMLA cream. This enhanced analgesia was sustained, improving patient outcomes.

Keywords:

Circumcision neonate pain restraint ring block

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Area of Science:

Pediatric Surgery
Pain Management
Quality Improvement

Background:

The American Academy of Pediatrics (AAP) recommends adequate analgesia for circumcision.
Ring block is effective, but topical EMLA (lidocaine and prilocaine) alone is insufficient.
Previous practice showed higher pain scores with resident performance or EMLA use.

Purpose of the Study:

To reduce pain scores and restraint duration during circumcision by 20% within six months.
To implement and sustain effective analgesia protocols for infant circumcision.

Main Methods:

A quality improvement (QI) project utilizing Plan-Do-Study-Act (PDSA) cycles.
Intervention: Policy change to discontinue EMLA and provide resident training on ring block technique.
Data collection over pre-intervention, intervention, and sustainability phases.

Main Results:

Mean restraint time reduced by 29% (attendings) and 15% (residents).
EMLA cream use was eliminated.
Mean pain scores decreased by 82% (residents) and 20% (attendings).
Pain scores above 3 were reduced by 100% for both groups.

Conclusions:

QI projects can effectively improve and sustain analgesia during circumcision.
Implementing evidence-based techniques like ring blocks significantly reduces pain and restraint.
The project demonstrated sustained improvements in pain management and procedure efficiency.