ANALGESIC INTERVENTIONS IN NEONATAL CIRCUMCISION: A NETWORK META-ANALYSIS Gabriel L. González , Gustavo R.M. Wegner, Bruno F.M. Wegner, Iaci L.L. Mattos, Catherine M.F. Werner, Fani Nhuch, Tatiana S. Nascimento INTRO • Circumcision is one of the most common neonatal procedure and is frequently done without analgesia; • Pain during circumcision may have neurodevelopmental consequences; • Neonatal pain scales present multiple limitations and many studies prefer pain derived physiological responses as surrogates for pain; Non-Cognitive Predictors of Student Success: • Many RCTs evaluate the role of regional and topical interventions, but there has been no study comparing all interventions in a unified framework. A Predictive Validity Comparison Between Domestic and International Students METHODS • Frequentist network meta-analysis; • Outcomes: intraoperative heart rate, peripheral oxygen saturation, their variation, respiratory rate and hematoma; • Continuous outcomes – MD; • Binary outcomes - RR; • Interventions: dorsal penile nerve block (DPNB), subcutaneous ring block (RB), topical eutectic mixture of local anesthetics (EMLA), topical lidocaine (TL), DPNB with EMLA, RB with EMLA, and no analgesia (control). Take a picture to download the extended content Regional anesthesia provides lower pain-related intraoperative responses in neonates undergoing circumcision. Level of certainty: RESULTS • 18 RCTs (1035 patients); • P-Score ranking (left→right); • Certainty of evidence with CINeMA framework (color graded); Non-Cognitive Predictors of Student Success: • Regional anesthesia, with or without EMLA, and EMLA alone, presented lower pain-related changes compared to topical or no analgesia; A Predictive Validity Comparison Between Domestic and International Students • DPNB showed better analgesia than EMLA, but higher risk of hematoma; • Subgroup analyses with term neonates and no SD estimations were aligned with results. DISCUSSION • Findings support the use of regional analgesia in neonatal circumcision; • EMLA presented lower heart rate than control, but did not consistently present clinical significance, thus its use should not substitute other techniques; • Low certainty of evidence was mainly due to the indirect nature of pain assessment; • Further limitations include reduced statistical power, sparse data, heterogeneous outcome definitions and various assessment methods