Combination Analgesia for Neonatal Circumcision: A Randomized Controlled Trial

Sharara‐Chami, Rana; Lakissian, Zavi; Charafeddine, Lama; Milad, Nadine; El-Hout, Yaser

doi:10.1542/peds.2017-1935

Cited by 25 publications

(27 citation statements)

References 32 publications

(24 reference statements)

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“…In the other study, the authors evaluated a multimodal regimen consisting of a ring block, a eutectic mixture of local anesthetic (EMLA) cream, oral sucrose, and a dorsal penile nerve block. 35 The Neonatal Infant Pain Scale (NIPS) score was significantly lower in the intervention groups compared with those who received the EMLA cream alone. The addition of the ring block with the EMLA cream and oral sucrose provided more effective analgesia than the dorsal penile nerve block, EMLA cream, and oral sucrose.…”

Section: Resultsmentioning

confidence: 91%

Regional anesthesia to ameliorate postoperative analgesia outcomes in pediatric surgical patients: an updated systematic review of randomized controlled trials

Kendall

Alves

Suh

et al. 2018

LRA

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Regional anesthesia is becoming increasingly popular among anesthesiologists in the management of postoperative analgesia following pediatric surgery. The main objective of this review was to systematically evaluate the last 5 years of randomized controlled trials on the role of regional anesthesia techniques in alleviating postoperative pain associated with various pediatric surgical procedures. Forty studies on 2,408 pediatric patients were evaluated. The majority of the articles published from 2013 to 2017 reported that the use of regional anesthesia minimized postoperative pain and reduced opioid consumption. Only a few surgical procedures (cholecystectomy, inguinal hernia repair, and non-laparoscopic major abdominal surgery) reported no significant difference in the postoperative pain relief compared with the standard anesthetic management. The growing number of randomized controlled trials in the pediatric literature is very promising; however, additional confirmation is needed to reinforce the use of specific regional anesthesia techniques to provide optimal postoperative pain relief for a few surgical procedures (reconstructive ear surgery, chest wall deformity, hypospadias, umbilical hernia, cleft palate repair) in pediatric patients. More randomized controlled trials are needed to establish regional anesthesia as an essential component of postoperative analgesia management in children.

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Section: Resultsmentioning

confidence: 91%

Regional anesthesia to ameliorate postoperative analgesia outcomes in pediatric surgical patients: an updated systematic review of randomized controlled trials

Kendall

Alves

Suh

et al. 2018

LRA

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“…Lidocaine with epinephrine should never be used because the vasoconstrictive properties of epinephrine increase the risk of ischemia and tissue necrosis. Topical anesthesia with EMLA cream (a eutectic mixture of lidocaine 2.5% and prilocaine 2.5%) is less effective alone but improves pain relief when used in combination with a ring block or dorsal penile nerve block [8].…”

Section: Neonatal Circumcisionmentioning

confidence: 99%

Surgery of the Male Genital Tract

Rew

2020

Family Medicine

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“…67e69 It was also found to be efficacious in decreasing pain associated with circumcision when combined with a regional block and/or oral sucrose. 70,71 However, care must be taken with regard to dosing, frequency of use, and time of administration especially in preterm infants, because it places the neonate at risk of methemoglobinemia, skin irritation, and toxicity. 72…”

Section: Local Anesthesia Neuraxial Blockadementioning

confidence: 99%

“…94 It is also effective in combination with EMLA with and without a local anesthetic block in relieving circumcisionassociated pain. 70 However, it is unclear whether there are adverse outcomes related to doseeresponse or tolerance.…”

Section: Nonpharmacologic Alternativesmentioning

confidence: 99%

Managing Procedural Pain in the Neonate Using an Opioid-sparing Approach

Squillaro

Mahdi

Tran

et al. 2019

Clinical Therapeutics

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Purpose: Pain in the neonate is often challenging to assess but important to control. Physicians often must balance the need for optimal pain control with the need to minimize oversedation and prolonged opioid use. Both inadequate pain control and overuse of opioids can have long-term consequences, including poor developmental outcomes. The aim of this review is to introduce a comprehensive approach to pain management for physicians, nurses, and surgeons caring for critically ill neonates, focusing on nonopioid alternatives to manage procedural pain. Findings: After review, categories of opioid-sparing interventions identified included (1) nonopioid pharmacologic agents, (2) local and regional anesthesia, and (3) nonpharmacologic alternatives. Nonopioid pharmacologic agents identified for neonatal use included acetaminophen, NSAIDs, dexmedetomidine, and gabapentin. Local and regional anesthesia included neuraxial blockade (spinals and epidurals), subcutaneous injections, and topical anesthesia. Nonpharmacologic agents uniquely available in the neonatal setting included skin-to-skin care, facilitated tucking, sucrose, breastfeeding, and nonnutritive sucking. Implications: The use of various pharmacologic and interventional treatments for neonatal pain management allows for the incorporation of opioidsparing techniques in neonates who are already at risk for poor neurodevelopmental outcomes. A multifactorial approach to pain control is paramount to optimize periprocedural comfort and to minimize the negative sequelae of uncontrolled pain in the neonate.

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Combination Analgesia for Neonatal Circumcision: A Randomized Controlled Trial

Abstract: During neonatal circumcision in boys, the most effective analgesia is RB combined with oral sucrose and EMLA cream.

Cited by 25 publications

References 32 publications

Regional anesthesia to ameliorate postoperative analgesia outcomes in pediatric surgical patients: an updated systematic review of randomized controlled trials

Regional anesthesia to ameliorate postoperative analgesia outcomes in pediatric surgical patients: an updated systematic review of randomized controlled trials

Surgery of the Male Genital Tract

Managing Procedural Pain in the Neonate Using an Opioid-sparing Approach

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