Penile Nerve Blc1ck Reduces the Physiologic Stress of Newborn Circumcision

Analgesia Versus Sedation During Broviac Catheter Placement

“…13 Circumcision has been shown to alter arterial oxygenation as measured by transcutaneous partial oxygen pressure monitoring 4 - 14 and/or O 2sat . 6 The results of our study confirm that the skin of the newborn is very sensitive to the physical and thermal stimulation provided during preoperative skin preparation and postoperative closure of the wound. This was indicated by the inability of secobarbital and fentanyl 2 |mg/kg to prevent decreases in O 2sat at these points in the procedure.…”

“…4 ' 6 ' 10 Penile nerve block with 4 mg lidocaine on each side during circumcision in healthy full-term infants prevented the increases in heart rate and systolic blood pressure seen in control patients. 6 Furthermore, lidocaine serum concentrations following local anesthesia were barely detectable. 6 The ability to metabolize and excrete lidocaine has been demonstrated in the fetus 11 and in premature infants.…”

“…6 Furthermore, lidocaine serum concentrations following local anesthesia were barely detectable. 6 The ability to metabolize and excrete lidocaine has been demonstrated in the fetus 11 and in premature infants. 12 A total lidocaine dose of up to 7 mg/kg is considered safe for local infiltration in pediatric patients; 10 thus, the 5 mg/kg dose used in this study was within recommended dosage.…”

“…It is now recognized that at the time of birth human infants have neuronal pathways and cerebral centers sufficiently developed to allow the perception of pain. 1 -3 It is also well established that fullterm and premature infants can mount substantial hormonal and metabolic responses to the stress of minor 4 and major surgical procedures 5 and that those responses can be modified by the administration of local 4 - 6 or systemic anesthetics. 78 Broviac catheter placement is a minor surgical procedure performed in approximately 10% of very low birthweight infants requiring long-term venous access for partial or total parenteral nutrition (TPN).…”

Rocking and pacifiers: Two comforting interventions for heelstick pain

“…Important clinical physiological and behavioral reactions have been observed in infants during pain-eliciting procedures. For instance, heart rate (HR) accelerates up to 40 beats per minute when the infant's heel is squeezed and then lanced to obtain a blood sample (Campos, 1989;Owens & Todt, 1984); arterial blood pressure and intracranial pressure rise during tracheal intubation of infants with compromised respiratory capacity (Kelly & Finer, 1984); cortisol levels increase after blood tests or surgical procedures such as circumcision (Gunnar, Malone, Vance, & Fisch, 1985); and transcutaneous oxygen pressure declines following circumcision (Maxwell, Yaster, & Wetzel, 1986). In sum, the physiological response of the infant undergoing painful procedures is one of extraordinarily intense arousal.…”