Al Qahtani 2014.

Methods	RCT Painful intervention: circumcision Study location: Day Care Surgery Department of Maternity and Children Hospital, Dammam City, Kingdom of Saudi Arabia Study period: January 2011 and April 2011
Participants	90 full‐term newborn males who underwent circumcision GA of 38 weeks or beyond, 5 min Apgar score of 8 or higher, PNA of 12 h or older and birthweight > 2500 g, and to be free from jaundice, anomalies of the penis, and analgesia or sedation in the previous 48 h
Interventions	2 mL oral sucrose (24% w/v) given through a dropper onto the tongue 2 min before the procedure (n = 30) EMLA cream: applied to the shaft of the penis with an occlusive dressing 1 h before the procedure (n = 30) Combination of EMLA cream + oral sucrose (n = 30): 1 g EMLA cream applied to the shaft of the penis with an occlusive dressing 1 h before the procedure + 2 mL oral sucrose (24% w/v) given through a dropper onto the tongue 2 min before the procedure
Outcomes	N‐PASS used to assess the severity of pain and neonatal response to pain, 5 min before, during and 5 min after the circumcision for all newborns. The scale measures both physiologic responses (HR, respiratory rate, blood pressure and oxygen saturation) and behavioural responses (crying irritability, behaviour state, facial expression and extremities tone) to pain
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	No information provided
Allocation concealment (selection bias)	Low risk	The sample was divided randomly into 3 groups. The envelope was opened to classify the neonate randomly to 1 of the groups in order to carry out the appropriate action
Blinding (performance bias and detection bias) All outcomes	High risk	Staff were not blinded
Blinding of outcome assessment (detection bias) All outcomes	High risk	Video imaging of the neonate 5 min before, during and until 10 min after the procedure showed the newborn reaction to pain and recorded the duration of crying. The videotapes were reviewed by an individual who was unaware of the infant’s treatment group, however, since the sucrose was applied 2 min before the procedure, it was probably possible to tell from the tapes which babies received sucrose
Incomplete outcome data (attrition bias) All outcomes	Low risk	Outcome data reported for all 90 infants
Selective reporting (reporting bias)	Unclear risk	The study protocol was not available to us so we could not judge whether there were any deviations from it
Other bias	Low risk	Appears free of other bias