Comparison of newborn circumcision pain to calcaneal heel puncture pain: is newborn circumcision pain control clinically warranted?
In newborns, elective male circumcision and calcaneal puncture for obtaining blood samples both cause pain. With elective male circumcision, dorsal penile nerve block (DPNB) is recommended for pain control, but no pain control is routinely recommended or used during calcaneal puncture. A prospective investigation was conducted to compare pain during elective circumcision (with and without DPNB) and calcaneal puncture to determine whether pain control should be used with the latter procedure. The study was conducted at a community hospital during a 4-month period. Two nurses observed newborn behavior during elective circumcision and routine calcaneal puncture and rated pain reactions by using a modified Gronigen Distress Scale. Ninety-one male newborns were circumcised without DPNB, and eight male newborns were circumcised with DPNB. Calcaneal puncture for blood samples was performed in 97 newborns (males and females). Pain scores during circumcision with and without DPNB were comparable with those during calcaneal puncture (2.1, 2.4, and 2.2, respectively). Pain control during circumcision may thus be considered, but caution should be taken that measures to prevent pain do not create new patient risk or additional pain.