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Table 1 Papers meeting the inclusion criteria, collected in chronological order

From: Analgesia for infants’ circumcision

Authors article

Newborns

Analgesia

Surgical technique

Pain scale

Results

Pub date

O’Sullivan et al. [17]

66

DPNB (ultrasound or anatomical landmark) / fentanyl

ukn*

FLACC

No significant difference between the groups in terms of fentanyl administration. The ultrasound technique took longer to perform but suggests some benefits in terms of postoperative pain.

2011

Banieghbal et al. [18]

583

RB/milk

Gomco

NIPS

RB causes a painful response in the majority of the babies, but this is mostly noted in babies over one week of age.

2009

Lehr et al. [19]

44

DPNB/EMLA/lidocaine

Gomco

NFCS/crying time

No significant difference in analgesic efficacy between treatments.

2007

Garry et al. [20]

18

DPNB/EMLA

ukn*

NIPS/numeric pain scale

DPNB is significantly more effective for pain relief than topical EMLA.

2006

Lehr et al. [21]

53

DPNB/EMLA/lidocaine

Gomco

Heart rate/respiratory rate/SpO2

No significant difference in analgesic efficacy between treatments.

2005

South et al. [22]

44

DPNB/Tylenol/non-nutritive sucking

Gomco

PIPP/crying time/ salivary cortisol level

NNS significantly decreases the pain response, in addition to other common analgesics.

2005

Razmus et al. [23]

132

DPNB/DPNB+sucrose/ DPNB+sucrose+EMLA/ EMLA/ EMLA+sucrose/ RB/ RB+sucrose solution/ sucrose solution

ukn*

FLACC

DPNB and RB in combination with the concentrated oral sucrose have the lowest pain scores. The sucrose alone does not provide sufficient analgesia; however, it can reduce the pain scores somewhat when used in conjunction with other analgesics.

2004

Malnory et al. [24]

53

Acetaminophen

Gomco

NIPS

Lower pain scores in newborns who received analgesia than placebo.

2003

Taeusch et al. [25]

59

DPNB/dextrose solution

Mogen vs PlastiBell

Cry response

The Mogen technique is preferred over the PlastiBell because of the simplicity of execution, and it is also associated with less pain and discomfort and it takes less time.

2002

Kaufman et al. [26]

57

EMLA/sucrose solution

Mogen vs Gomco

Crying time/ facial grimancing

Mogen appears a better procedure than Gomco, and it takes less time, showing also that the use of analgesia is imperative.

2002

Macke et al. [27]

60

Acetaminophen

Gomco

NCAFS/crying time/heart rate

No significant difference in analgesic efficacy between treatments and placebo.

2001

Joyce et al. [28]

23

EMLA/music

ukn*

RIPS/heart rate/SpO2/salivary cortisol level/crying time

Efficacy of EMLA and music to contribute to the pain relief of neonates undergoing circumcision.

2001

Kass et al. [29]

71

DPNB/dextrose solution

Gomco

MBPS/ crying time/heart rate/respiratory rate

No significant differences between the oral glucose and water groups among any of the pain-related measurements; only the use of DPNB shows significantly lower pain scores and reduced objective measurements of pain and physiologic stress.

2001

Taddio et al. [30]

86

DPNB/EMLA/acetaminophen

Mogen vs Gomco

NFCS/crying time

Infants circumcised with the Mogen clamp and combined analgesia have also less pain than those circumcised with the Gomco clamp and EMLA cream, and it also takes less time.

2000

  1. *No data was available regarding the specific surgical procedure to perform MC.
  2. Abbreviations: NIPS Neonatal infant pain scale, RIPS Riley infant pain scale, PIPP Premature infant pain profile, MBPS Modified behavioral pain scale, NFCS neonatal face coding system, NCAFS nursing child assessment feeding scale, DPNB Dorsal penile nerve block, RB Ring block.