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

Gabriel Lemos Gonzalez; 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

doi:10.1038/s41372-026-02878-5

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

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

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

Journal of perinatology

08/20/2026

DOI: 10.1038/s41372-026-02878-5

PMID: 42624889

Appears in UI Libraries Support Open Access

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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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Details

Title: Subtitle: Local anesthetic techniques for analgesia in neonatal circumcision: a network meta-analysis
Creators: Gabriel Lemos Gonzalez - Universidade Federal do Estado do Rio de Janeiro
Gustavo Roberto Minetto Wegner - Universidade de Passo Fundo
Bruno Francisco Minetto Wegner - Universidade Federal do Rio Grande do Sul
Iaci Luisa Lopes de Mattos - Universidade Federal do Estado do Rio de Janeiro
Catherine Maria Fasano Werner - Universidade Estadual de Londrina
Fani Nhuch - University of Washington
Vitor Alves Felippe - Instituto Nacional de Câncer - INCA
Tatiana Souza Nascimento - University of Iowa, Anesthesia
Resource Type: Journal article
Publication Details: Journal of perinatology
DOI: 10.1038/s41372-026-02878-5
PMID: 42624889
ISSN: 0743-8346
eISSN: 1476-5543
Publisher: Springer Nature
Number of pages: 8
Language: English
Electronic publication date: 08/20/2026
Academic Unit: Anesthesia
Record Identifier: 9985236972402771

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