MP30-19 THE RAKAI SCORE: A NOVEL TOOL FOR PAIN MEASUREMENT DURING EARLY INFANT MALE CIRCUMCISION WITH THE SHANGRING

Abstract

You have accessJournal of UrologyCME1 May 2022MP30-19 THE RAKAI SCORE: A NOVEL TOOL FOR PAIN MEASUREMENT DURING EARLY INFANT MALE CIRCUMCISION WITH THE SHANGRING Aaron Brant, Christina Sze, Jeffrey Johnson, Spyridon Basourakos, Quincy Nang, Stephen Kiboneka, Joseph Kagayi, Alice Christensen, Mark Barone, Marc Goldstein, Kaylee Ho, Karla Ballman, Philip Li, Godfrey Kigozi, and Richard Lee Aaron BrantAaron Brant More articles by this author , Christina SzeChristina Sze More articles by this author , Jeffrey JohnsonJeffrey Johnson More articles by this author , Spyridon BasourakosSpyridon Basourakos More articles by this author , Quincy NangQuincy Nang More articles by this author , Stephen KibonekaStephen Kiboneka More articles by this author , Joseph KagayiJoseph Kagayi More articles by this author , Alice ChristensenAlice Christensen More articles by this author , Mark BaroneMark Barone More articles by this author , Marc GoldsteinMarc Goldstein More articles by this author , Kaylee HoKaylee Ho More articles by this author , Karla BallmanKarla Ballman More articles by this author , Philip LiPhilip Li More articles by this author , Godfrey KigoziGodfrey Kigozi More articles by this author , and Richard LeeRichard Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002573.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Measurement of pain in infants can be challenging due to an inability to communicate level of discomfort directly. Therefore, providers are forced to rely on secondary proxies for discomfort, resulting in a nonspecific or inaccurate measurement. In this study, we present the use of the novel Rakai scale for the measurement of pain during early infant circumcision (EIMC) using ShangRing (SR) in our recent clinical trials in Uganda, Tanzania, and Kenya. METHODS: Male infants aged 0 – 60 days were brought to 14 sites in Kenya, Tanzania, and Uganda by a parent or legally appointed representative for SR EIMC from February to December 2020. Infants with congenital genitourinary anomalies, bleeding diatheses, or allergy to local anesthetics were excluded. Topical anesthesia was administered, with additional local injectable anesthesia given if needed. Infants were scored on both the nine-point Rakai scale during SR placement (Table 1) as well as the seven-point Neonatal Infant Pain Scale (NIPS) post-operatively. RESULTS: Rakai and NIPS scores were completed for 1,690 of 1,691 infants (99.9%) who underwent SR placement. The mean procedure time was 10.1 minutes (standard deviation (STD): 5.3). Additional injectable anesthesia was needed for 44 infants (2.6%). Mean Rakai Score was 3.6 of 9 (STD: 2.6). The highest scored portion of the procedure was “skin adjustment with the ring in place” (mean 0.52 of 1), and the lowest scored portion was “placement of hemostats” (mean 0.24 of 1). Severe Rakai Score (>6 of 9) was recorded in 303 infants (17.9%). Mean NIPS Score was 0.3 of 7 (STD: 0.8), with “flexed or extended arms” the highest scored portion (mean 0.06 of 1). A severe NIPS score (≥5 of 7) was recorded in 8 infants (0.5%). CONCLUSIONS: In a large prospective study of male newborn infants undergoing SR placement, the Rakai Score captured infant pain at each step of the procedure with a higher rate of severe pain detection than the NIPS score administered post-operatively. Thus, the Rakai score may be superior to pre-existing tools such as the NIPS score for pain measurement during SR EIMC due to its detection of intraprocedural pain with more significant detection of severe pain. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e486 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aaron Brant More articles by this author Christina Sze More articles by this author Jeffrey Johnson More articles by this author Spyridon Basourakos More articles by this author Quincy Nang More articles by this author Stephen Kiboneka More articles by this author Joseph Kagayi More articles by this author Alice Christensen More articles by this author Mark Barone More articles by this author Marc Goldstein More articles by this author Kaylee Ho More articles by this author Karla Ballman More articles by this author Philip Li More articles by this author Godfrey Kigozi More articles by this author Richard Lee More articles by this author Expand All Advertisement PDF DownloadLoading ...