The Effect of Distraction Techniques on Pain, Fear, and Anxiety in Children Undergoing Circumcision: A Meta-Analysis of Randomized Controlled Trials

Abstract

Circumcision is a common pediatric operation, and distraction technique can be used as an adjunct analgesic method during the perioperative period. The study aims to explore the effect of distraction techniques on reducing pain, fear, and anxiety in children undergoing circumcision. The PubMed, ClinicalTrials.gov, and Embase databases were searched for articles published from January 1, 2000, to December 31, 2023. Only randomized controlled trials (RCTs) were included. Meta-analysis and forest plots were carried out using Review Manager 5.4.1 software, and outcomes were reviewed by two authors independently. We used the Risk of Bias assessment form (ROB2) developed by the Cochrane Collaboration to assess the quality of included studies. PRISMA 2020 guidelines were used in this article to achieve the quantitative and qualitative synthesis of data. A total of seven RCTs were included. The intervention group consisted of 417 patients, while the control group had 245 patients. The meta-analysis and sensitivity analysis results showed that the distraction technique could significantly relieve pain (MD −1.3, 95% confidence interval [CI]: [−1.61 to −0.99], p < .00001), fear (SMD −1.04, 95%CI −1.68 to −0.4, p = .001), and anxiety (SMD −1.07, 95%CI [−1.64 to −0.51], p = .0002). Similarly, therapeutic play significant could significantly relieve fear (MD −0.4, 95%CI [−0.71 to −0.1], p = .01) and anxiety (SMD -1.31, 95%CI [−2.59 to −0.04], p = .04), virtual reality (VR) could significantly relieve anxiety (SMD −0.67, 95%CI [−0.98 to −0.37], p < .0001). Distraction techniques can alleviate perioperative pain, fear, and anxiety in children undergoing circumcision.