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Neonatal circumcision. Randomized trial of a sucrose pacifier for pain control
M Herschel1, B Khoshnood, C Ellman
1Department of Pediatrics, University of Chicago Pritzker School of Medicine, Ill, USA. mhersche@midway.uchicago.edu
Objective:
To assess the effectiveness of oral sucrose via a nipple compared with no treatment and dorsal penile nerve block (DPNB) for alleviating pain in neonatal circumcision.
Design:
Randomized control trial. Data analysis performed by investigators blinded to the 3 treatment groups.
Setting:
University teaching hospital, General Care Nursery.
Patients:
One hundred nineteen full-term male, normal birth weight neonates, 12 hours old or older.
Interventions:
No treatment (our standard care), DPNB, or oral sucrose prior to circumcision.
Main Outcome Measures:
Differences between groups in heart rate and oxygen saturation changes from baseline during specified intervals of the circumcision procedure. Differences between groups in loss of data due to episodes of excessive motion.
Results:
Sucrose gave significant (P < .001) pain relief compared with the no treatment control throughout most of the circumcision and particularly in the early stages of the procedure. Overall, the average difference in the elevation of heart rates during the circumcision operative procedure among the 3 groups and the 95% confidence intervals (CIs) were as follows: control vs DPNB, 27.1 beats/min (17.6, 36.6) and control vs sucrose, 9.7 beats/min (0.1, 19.3). Furthermore, newborns who received either DPNB or sucrose had less loss of oxygen saturation data due to excessive motion during the procedure than the no-treatment controls. The total percentages of lost data due to excessive motion in the 3 groups were 31% for control, 10% for DPNB, and 8% for sucrose. Relative risk and 95% CIs were: DPNB vs control, 0.32 (0.23, 0.43); sucrose vs control, 0.26 (0.18, 0.36). Differences in oxygen saturation among the 3 groups during the circumcision operative procedure were statistically (P < .001), but perhaps not clinically, significant. However, the analysis did not include missing data due to excessive motion, which occurred predominantly in the no-treatment control group.
Conclusion:
Sucrose on a pacifier is an inexpensive and effective method for pain relief in neonatal circumcision when DPNB is not desirable.