ANALGESIC TECHNIQUES FOR PAIN MANAGEMENT IN NON-NEONATAL CIRCUMCISION: A NETWORK META-ANALYSIS Gabriel L. González , Gustavo R. M. Wegner, Bruno F. M. Wegner, Iaci L. L. Mattos, Lucas C. Neves, Mariana T. Ricci, Raquel V. Torres, Catherine M. F. Werner, Tatiana S. Nascimento INTRO • Circumcision is a painful procedure performed in around 30% of all males; • Non-neonatal pediatric circumcision is potentially more painful than neonatal; • There are many regional, topical and systemic anesthetic techniques available; • Systemic analgesics are usually part of a broader multimodal approach, making individual effect harder to differentiate; • Regional and topical analgesia are evaluated in many RCTs and some pairwise meta-analyses; Non-Cognitive Predictors of Student Success: A Predictive Validity Comparison Between Domestic and International Students • No study has compared regional and topical analgesic techniques in a unified framework. METHODS • Frequentist network meta-analysis in children (28 days to 18 years); • Outcomes: postoperative pain (SMD) and need for rescue analgesia (RR); • Interventions: dorsal penile nerve block (DPNB), caudal block (CB), ring block (RB), pudendal nerve block (PNB), topical anesthetics (TO), DPNB + RB, DPNB + TO, DPNB + CB, ultrasound-guided (US-) DPNB, US-PNB, US-ESP, US-CB, no analgesia (control), and only systemic analgesics (Control-S). Take a picture to download the extended content Ultrasound-guided, caudal, pudendal and combined blocks presented better analgesia in pediatric patients undergoing circumcision. Level of certainty: RESULTS • 39 RCTs (2790 patients); • Results and 95% CI in league tables; • P-Score ranking (left to right order); • Certainty of evidence with CINeMA framework (color graded); Non-Cognitive Predictors of Student Success: • PNB presented lower early postoperative pain than several blocks, TO and control-S, and TO presented higher pain than most blocks, but there were global inconsistency in these outcomes; A Predictive Validity Comparison Between Domestic and International Students • CB, ultrasound-guided variants, and DPNB+RB presented reduced need for rescue analgesia compared to topical and control; • Subgroup analyses restricting to behavioral pain scales, no systemic analgesics and general anesthesia were aligned with results. DISCUSSION • Ultrasound-guided, neuraxial and proximal nerve blocks present higher quality of analgesia than distant (DPNB and RB) blocks, TO and no intervention; • Findings are backed by physiological reasoning and support the use of regional blocks in non-neonatal pediatric circumcision; • Sparse network geometry, reliance on mostly indirect evidence and heterogeneous protocols warrant cautious interpretation.