Pre-emptive penile ring block with sucrose analgesia reduces pain response to neonatal circumcision.

OBJECTIVE: To compare retrospective use of oral sucrose (SUC) vs oral sucrose plus lidocaine ring block (SUC + RB) in the management of pain during neonatal circumcision. METHODS: A retrospective review of medical records of newborns circumcised using the "Neonatal Infant Pain Scale" was done. RESULTS: With regard to pain, the SUC group had a significantly greater percentage of those with pain than the SUC + RB group at 1 minute (77.7% vs 69.4%; P = .01) and 5 minutes (65.7% vs 55.7%; P = .004). There was no significant pain difference at 30 minutes. In the multivariate logistic regression analyses, those in the SUC group had significantly greater odds for pain at 1 minute than those in the SUC + RB group (odds ratio 1.45, 95% confidence interval 1.04-2.02; P = .03). No significant difference was noted at 5 minutes. Each of the SUC and SUC + RB groups had significant decreases in pain percentages at 5 minutes and 30 minutes (P <.001). In addition, post-term gestational age had significantly greater odds for pain at 5 minutes (odds ratio 3.67, 95% confidence interval 1.51-8.93; P = .004). CONCLUSION: We found that sucrose use alone as compared with sucrose and ring block combined had greater odds for pain at 1 minute but not at 5 minutes. In addition, those with post-term gestational age had greater odds for pain at 5 minutes as compared with those with regular gestational age. We recommend for hospital-based circumcision using clamps, the use of combined sucrose and ring block for increased analgesia. In addition, for post-term neonates, we recommend greater focus on pain levels, including considering higher dosages of pain medications.

Use of an intubating stylet as a guide to complete uterine curettage complicated by uterine perforation.

Completion of uterine curettage may be challenging following uterine perforation even under sonographic and laparoscopic monitoring. This report illustrates the use of a flexible intubating stylet as a guide to place the suction curette into the uterine cavity when sonography and laparoscopy alone are not successful. Use of a malleable instrument such as an intubating stylet as a guide should be considered an option when insertion of the suction curette into the uterine cavity is complicated by anatomic variation and uterine perforation.