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Local anesthetic techniques for analgesia in neonatal circumcision: a network meta-analysis
Gabriel Lemos González1, Gustavo Roberto Minetto Wegner2, Bruno Francisco Minetto Wegner3
1Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil.
Objective:
Neonatal circumcision is often performed without adequate analgesia despite significant harm related to acute pain. We compared local anesthetic techniques using network meta-analysis based on intraoperative physiological responses.
Study Design:
Frequentist network meta-analysis of randomized controlled trials comparing nerve blocks (dorsal penile nerve block, DPNB; ring block, RB), topical anesthetics (eutectic mixture of local anesthetics, EMLA; topical lidocaine, TL), combination techniques, and control.
Outcomes:
intraoperative heart rate, oxygen saturation, their variation, respiratory rate, and hematoma. Risk of bias and certainty of evidence were assessed.
Results:
Eighteen trials (1 035 neonates) were included. Nerve blocks reduced pain-related responses versus control and TL. DPNB outperformed EMLA, with increased hematoma risk. Meta-regression suggests smaller effect size in recent studies.
Conclusions:
Evidence supports local anesthetic techniques for neonatal circumcision, with nerve blocks providing greater benefit than topical anesthetics. However, given the small sample sizes and low certainty of evidence, higher-quality trials are needed.
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