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Beyond dorsal penile nerve block: a more humane circumcision
H J Stang1, L W Snellman, L M Condon
1Department of Pediatrics and Adolescent Medicine, Group Health, Inc., White Bear Lake, MN 55110, USA.
Pediatrics
|August 1, 1997
Summary
Newborn circumcision pain can be reduced using a sucrose pacifier and a comfortable restraint, in addition to the dorsal penile nerve block (DPNB). These methods enhance the humane care of neonates during routine procedures.
Area of Science:
- Neonatal care
- Pediatric surgery
- Pain management
Background:
- Routine neonatal circumcision is a common procedure.
- Minimizing infant distress and pain is crucial for humane care.
- The dorsal penile nerve block (DPNB) is a standard analgesic technique.
Purpose of the Study:
- To evaluate additional pain and stress reduction techniques for neonatal circumcision.
- To compare the efficacy of a specialized restraint chair, buffered lidocaine, and sucrose solution against standard care.
Main Methods:
- A prospective, randomized, double-blind, placebo-controlled study involving 80 healthy term male infants.
- Four groups were compared: standard care (restraint board, DPNB, water pacifier), specialized restraint chair, buffered lidocaine for DPNB, or sucrose-dipped pacifier.
- Behavioral distress scores and plasma cortisol levels were measured.
Main Results:
- The specialized restraint chair significantly reduced infant distress by over 50% compared to the standard restraint.
- A pacifier dipped in 24% sucrose solution effectively reduced distress during DPNB and circumcision.
- Buffered lidocaine did not show a significant difference in distress reduction compared to standard DPNB.
Conclusions:
- A padded, physiologic restraint and a sucrose-dipped pacifier, when used with DPNB, can decrease pain and distress during neonatal circumcision.
- These adjuncts contribute to a more humane circumcision procedure for neonates.
- Plasma cortisol levels were not significantly altered by the tested interventions.