Local anesthetic techniques for analgesia in neonatal circumcision: a network meta-analysis.

IF 2.3 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Journal of Perinatology Pub Date : 2026-08-20 DOI:10.1038/s41372-026-02878-5

Gabriel Lemos González, Gustavo Roberto Minetto Wegner, Bruno Francisco Minetto Wegner, Iaci Luisa Lopes de Mattos, Catherine Maria Fasano Werner, Fani Nhuch, Vitor Alves Felippe, Tatiana Souza Nascimento

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引用次数: 0

Abstract

Objective: Neonatal circumcision is often performed without adequate analgesia despite significant harm related to acute pain. We compared local anesthetic techniques using network meta-analysis based on intraoperative physiological responses.

Study design: Frequentist network meta-analysis of randomized controlled trials comparing nerve blocks (dorsal penile nerve block, DPNB; ring block, RB), topical anesthetics (eutectic mixture of local anesthetics, EMLA; topical lidocaine, TL), combination techniques, and control.

Outcomes: intraoperative heart rate, oxygen saturation, their variation, respiratory rate, and hematoma. Risk of bias and certainty of evidence were assessed.

Results: Eighteen trials (1 035 neonates) were included. Nerve blocks reduced pain-related responses versus control and TL. DPNB outperformed EMLA, with increased hematoma risk. Meta-regression suggests smaller effect size in recent studies.

Conclusions: Evidence supports local anesthetic techniques for neonatal circumcision, with nerve blocks providing greater benefit than topical anesthetics. However, given the small sample sizes and low certainty of evidence, higher-quality trials are needed.

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新生儿包皮环切术的局部麻醉镇痛技术：网络荟萃分析。

目的：新生儿包皮环切术通常在没有足够的镇痛的情况下进行，尽管存在与急性疼痛相关的重大伤害。我们使用基于术中生理反应的网络荟萃分析来比较局麻技术。研究设计：对随机对照试验进行频率网络荟萃分析，比较神经阻滞（阴茎背神经阻滞，DPNB；环阻滞，RB）、局部麻醉剂（局麻药共溶混合物，EMLA；局部利多卡因，TL）、联合技术和对照组。结果：术中心率、血氧饱和度及其变化、呼吸频率和血肿。评估偏倚风险和证据的确定性。结果：纳入18项试验（1035例新生儿）。与对照组和TL相比，神经阻滞降低了疼痛相关反应。DPNB优于EMLA，但血肿风险增加。元回归表明，在最近的研究中，效应大小较小。结论：有证据支持局部麻醉技术用于新生儿包皮环切术，神经阻滞比表面麻醉更有效。然而，由于样本量小，证据的确定性低，需要更高质量的试验。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Perinatology 医学-妇产科学

CiteScore

5.40

自引率

6.90%

发文量

284

审稿时长

3-8 weeks

期刊介绍： The Journal of Perinatology provides members of the perinatal/neonatal healthcare team with original information pertinent to improving maternal/fetal and neonatal care. We publish peer-reviewed clinical research articles, state-of-the art reviews, comments, quality improvement reports, and letters to the editor. Articles published in the Journal of Perinatology embrace the full scope of the specialty, including clinical, professional, political, administrative and educational aspects. The Journal also explores legal and ethical issues, neonatal technology and product development. The Journal’s audience includes all those that participate in perinatal/neonatal care, including, but not limited to neonatologists, perinatologists, perinatal epidemiologists, pediatricians and pediatric subspecialists, surgeons, neonatal and perinatal nurses, respiratory therapists, pharmacists, social workers, dieticians, speech and hearing experts, other allied health professionals, as well as subspecialists who participate in patient care including radiologists, laboratory medicine and pathologists.