11

Procedural Pain Management

There are many reasons a neonate can experience pain. Pain can be caused by trauma (such as a traumatic delivery), a pathological condition or anomaly, or from an invasive procedure.

Table 11.1 describes some of the common painful procedures experienced by the neonate in the neonatal intensive care unit (NICU).

CIRCUMCISION

Male circumcision, or removal of the foreskin or prepuce from the penis, is a common procedure performed on neonates for religious, cultural, or personal reasons. Although circumcision can be performed at any time in life, it is most completely performed during the neonatal period. There has been a move away from performing it in the hospital before a newborn is ­discharged; it is more commonly performed during a follow-up pediatric visit to ensure the baby has fully transitioned to extrauterine life and that breastfeeding is well established.

Pain management during circumcision varies, with some procedures still receiving no analgesia at all. The American Academy of Pediatrics (AAP) recommends that pharmacological methods be used, as nonpharmacological methods alone are insufficient at managing pain during this procedure. Adequate analgesia, such as topical 4% lidocaine, dorsal penile nerve block (DPNB), and a subcutaneous ring block are all effective options, although the AAP task force found the subcutaneous ring block to be the most effective. The task force also found that infants who were circumcised without analgesia demonstrated an increased behavioral response to routine immunizations at 4 to 6 months compared to infants with adequate pain management (AAP, 2012).

TABLE 11.1  Common Invasive Procedures in the NICU

NICU, neonatal intensive care unit.

Adapted from Anand et al. (2005).

HEEL LANCE

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