Physiologic Stress Reduction by a Local Anesthetic During Newborn Circumcision

Williamson, Paul; Williamson, Megan

doi:10.1016/s0022-5347(17)51370-1

Cited by 39 publications

(60 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Mean fall of SpO 2 was maximum in control group and minimum in 50% glucose group. Singh et al [14] and Williamson et al [15] found a similar fall in SpO 2 in their respective studies. Neonates in all groups expressed pain in the form of change in their facial expressions.…”

Section: Discussionsupporting

confidence: 53%

Analgesic Effect of Oral Glucose in Neonates

Jatana¹,

Dalal²,

Wilson

2003

Medical Journal Armed Forces India

View full text Add to dashboard Cite

The International Association for the Study of Pain, has defined pain as "an unpleasant sensory and emotional experience connected with actual or potential tissue damage or described in terms of such damage". It was thought that the newborn baby does not experience pain because of incompletely developed nervous system. However, it has been shown that neurological system known to be associated with pain transmission and modulation, is intact and functional. A study was conducted in our center to study the analgesic effect of administration of oral glucose in various concentrations, in neonates undergoing heel punctures, for collection of blood for investigations. This was compared with the analgesic effects of breast milk (which contains lactose). 125 full term normal neonates with no history of birth asphyxia or underlying neurological abnormality, requiring heel punctures for collection of blood for various investigations were selected for the study. They were matched for gestational age, birth weight and sex distribution and divided into 5 groups of 25 each. One group comprised control subjects and was administered sterile water. 3 groups were administered 1 ml of varying strengths of glucose solutions i.e. 10%, 25% and 50% respectively. The last group was given 1 ml of expressed breast milk (EBM). Prior to heel pricks, state of arousal, baseline heart rate (HR) and transcutaneous oxygen saturation (SpO 2 ) were recorded by pulse oximeter in each neonate. Autolet, a mechanical device for capillary sampling, was used for heel pricks to give equal strength of painful stimulus in each procedure. Audio tape recorder was used to record the cry. The oral solution was administered slowly over 30 seconds by means of a syringe placed in the mouth. Heel puncture was done after 2 minutes, taking all aseptic precautions. HR and SpO 2 were monitored using pulse oximeter. Pain response was assessed, by recording duration of crying, change in HR, change in SpO 2 and facial action score after the procedure. Mean duration of cry and total cry over 5 minutes was significantly less in groups given 25% and 50% glucose solutions as compared to the control group and babies given EBM. Difference in mean increase in HR, fall in SpO 2 were statistically significant between control group, EBM group and neonates given 25% and 50% glucose solutions respectively. Compared to control group, all other administered solutions (10%, 25%, 50% glucose and EBM) were found to reduce physiological and behavioral responses in neonates undergoing heel punctures. 25% and 50% glucose solutions were found to have maximal analgesic effect and both were found to be equally effective. EBM and 10% glucose solution have an equal analgesic effect but less than 25% or 50% glucose. This simple, cheap and safe method of oral analgesia can be easily used in neonates undergoing heel prick procedures during routine neonatal care. MJAFI 2003; 59 : 100-104

show abstract

Section: Discussionsupporting

confidence: 53%

Analgesic Effect of Oral Glucose in Neonates

Jatana¹,

Dalal²,

Wilson

2003

Medical Journal Armed Forces India

View full text Add to dashboard Cite

show abstract

“…In fact, evidence for the effectiveness of oral or topical analgesics for mild to moderately painful procedures in newborn infants has been mixed, with some studies reporting positive, but more reporting negative results (Blass and Barr 2000). However, even with an analgesic for which there is consistent evidence of effectiveness, such as the use of lidocaine as a dorsal penile nerve block (DPNB) for circumcision (Holve et al 1983;Williamson and Williamson 1983;Maxwell et al;1987, Stang et al 1997, caregiving modalities may play an important role. With the objective of making circumcision 'more humane', Stang and his colleagues (1997) compared DPNB analgesia provided (1) with the infant strapped with limbs extended to a rigid circumcision board, (2) with the infant strapped with limbs flexed in a soft restraint chair, and (3) in a rigid chair with 24% sucrose solution delivered by pacifier.…”

Section: Discussionmentioning

confidence: 99%

Contact and nutrient caregiving effects on newborn infant pain responses

Gormally

Barr

Wertheim

et al. 2001

Develop Med Child Neuro

View full text Add to dashboard Cite

To understand how the 'caregiving context' could affect responses to procedural pain, the authors sought to determine whether (1) the combined effects of sweet taste and holding (caregiving contact) were greater than the effects of either alone, (2) any combined effects were additive or interactive, and (3) the interventions had similar effects on behavioral (crying and facial activity) and physiological (heart rate, vagal tone) responses to the heel-stick procedure in newborn infants in a randomized two-factorial intervention trial. Eighty-five normally developing newborn infants were studied with a mean gestational age of 39.4 weeks on the 2nd or 3rd day of life. Infants were randomized in blocks of eight to receive (1) no holding and water taste (control participants), (2) no holding and sucrose taste (sucrose group), (3) holding and water taste (holding group), or (4) holding and sucrose taste (holding and sucrose group). Crying was reduced significantly by taste and holding, and the interventions combined additively. Facial activity was only significantly reduced by holding. For physiological measures, the interventions interacted with each other and preintervention levels to reduce heart rate and lower vagal tone more during the procedure in infants in whom heart rate and vagal tone were higher before intervention. Consequently, sweet taste and holding interventions combined in complex ways when acting on different behavioral and physiological response systems to modify stressful pain experiences. The results suggest that providing a caregiving context when painful procedures are performed may be a simple and practical method of reducing pain experience in infants, and that no one measure captures these effects.Coping with pain and stress is a critical challenge throughout life. Such challenges are usually faced by the infant in the presence of a caregiver in all mammalian species, a notable exception being the performance of medically indicated procedures in human infants. Prototypical components of the caregiving context are contact and the delivery of nutrients by the mother. It should not, therefore, be surprising if these caregiving components were important determinants of an infant's ability to cope with pain and stress. Extensive literature on non-human infant species has described a large number of biological and behavioral 'hidden regulators' (Hofer 1994) that modify infant responses to pain and stress stimuli (see also, Blass et al. 1995, Panksepp 1998. Of particular interest to the present study is evidence for at least two functionally separate pathways, one mediated by nutrient stimuli (taste) and one by contact. If these pathways are active in human infants, then their effects may be similar and overlapping, additive, or interactive. Furthermore, when minor painful procedures are performed, the caregiving context may be able to be modified to exploit these pathways to minimize procedural stress.Compared to adults, understanding pain responses in infants poses unique challenges of measuremen...

show abstract

“…Compared with control subjects who received no analgesia, neonates with DPNB cry 45% to 76% less, 39,49 -51 have 34% to 50% smaller increases in heart rate, 50,52 and have smaller decreases in oxygen saturation during the procedure. 39,52 Additionally, DPNB lidocaine attenuates the adrenocortical stress response compared with control subjects who received no injections or injections of saline. 49 The technique of Kirya and Werthmann is used most commonly to perform the block.…”

Section: Dorsal Penile Nerve Block (Dpnb)mentioning

confidence: 99%

Circumcision Policy Statement

Lannon¹,

Bailey²,

Fleischman³

et al. 1999

Pediatrics

338

View full text Add to dashboard Cite

ABSTRACT. Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided.ABBREVIATIONS. UTI, urinary tract infection; STD, sexually transmitted disease; NCHS, National Center for Health Statistics; DPNB, dorsal penile nerve block; SCCP, squamous cell carcinoma of the penis; HPV, human papilloma virus; HIV, human immunodeficiency virus.A lthough 1 the exact frequency is unknown, it is estimated that 1.2 million newborn males are circumcised in the United States annually at a cost of between $150 and $270 million. This practice has been advocated for reasons that vary from symbolic ritual to preventive health measure. Until the last half century, there has been limited scientific evidence to support or repudiate the routine practice of male circumcision.Over the past several decades, the American Academy of Pediatrics has published several policy statements on neonatal circumcision of the male infant. [1][2][3] Beginning in its 1971 manual, Standards and Recommendations of Hospital Care of Newborn Infants, and reiterated in the 1975 and 1983 revisions, the Academy concluded that there was no absolute medical indication for routine circumcision.In 1989, because of new research on circumcision status and urinary tract infection (UTI) and sexually transmitted disease (STD)/acquired immunodeficiency syndrome, the Academy concluded that newborn male circumcision has potential medical benefits and advantages as well as disadvantages and risks.4 This statement also recommended that when circumcision is considered, the benefits and risks should be explained to the parents and informed consent obtained. Subsequently, a number of medical societies in the developed world have published statements that do not recommend routine circumcision of male newborns. [5][6][7] In its position statement, the Australian College of Paediatrics emphasized that in all cases, the medical attendant should avoid exaggeration of either risks or benefits of this procedure. 5Because of the ongoing debate, as well as the publication of new research, it was appropriate to reevaluate the issue of routine neonatal circumcision. This Task Force adopted an evidence-based approach to analyzing the medical literature concerning circumcision. The studies reviewed were obtained through a search of the English language medical literature from 1960 to the present and, additionally, through a search of the bibliographies of the published studies. EPIDEMIOLOGYThe percentage of male infants circumcised va...

show abstract

Physiologic Stress Reduction by a Local Anesthetic During Newborn Circumcision

Cited by 39 publications

References 0 publications

Analgesic Effect of Oral Glucose in Neonates

Analgesic Effect of Oral Glucose in Neonates

Contact and nutrient caregiving effects on newborn infant pain responses

Circumcision Policy Statement

Contact Info

Product

Resources

About