A randomized, controlled trial of a eutectic mixture of local anesthetic cream (lidocaine and prilocaine) versus penile nerve block for pain relief during circumcision.

OBJECTIVE We set out to compare a eutectic mixture of local anesthetic cream (lidocaine and prilocaine) to dorsal penile nerve block with lidocaine for anesthesia during circumcision. STUDY DESIGN In a double-blind study, term newborns were randomized to local anesthetic cream and sodium chloride solution dorsal penile nerve block (n = 31) or to placebo cream and lidocaine dorsal penile nerve block (n = 29). Pain was assessed by determination of heart rate, respiratory rate, and behavioral distress scoring. Group differences were evaluated with repeat-measures analyses of variance. RESULTS Distress scores and heart rates were significantly higher in the eutectic mixture group than in the lidocaine group. Respiratory rates were higher in the eutectic mixture group but did not reach statistical significance. CONCLUSIONS Distress scores and heart rates were significantly higher in infants treated with the anesthetic mixture than in infants treated with lidocaine. Dorsal penile nerve block with lidocaine is a more efficacious means of providing anesthesia for neonatal circumcision than the mixture of local anesthetics.

[1]  R. Engel,et al.  The effect of circumcision on transcutaneous PO2 in term infants. , 1980, American journal of diseases of children.

[2]  Megan R. Gunnar,et al.  Local Anesthesia for Neonatal Circumcision: Effects on Distress and Cortisol Response , 1988 .

[3]  K. Craig,et al.  EFFICACY AND SAFETY OF LIDOCAINE-PRILOCAINE CREAM FOR PAIN DURING CIRCUMCISION , 1997 .

[4]  R. Guillet,et al.  Analgesia for Neonatal Circumcision: A Randomized Controlled Trial of EMLA Cream Versus Dorsal Penile Nerve Block , 1998, Pediatrics.

[5]  A. R. Fleischman,et al.  Circumcision Policy Statement , 1999, Pediatric Clinical Practice Guidelines & Policies.

[6]  F. Howard,et al.  Neonatal Circumcision and Pain Relief: Current Training Practices , 1998, Pediatrics.

[7]  E. O. Horger,et al.  Effectiveness of 1% lidocaine dorsal penile nerve block in infant circumcision. , 1990, American journal of obstetrics and gynecology.

[8]  K. Anand,et al.  Relationships between stress responses and clinical outcome in newborns, infants, and children. , 1993, Critical care medicine.

[9]  F. Howard,et al.  Acetaminophen analgesia in neonatal circumcision: the effect on pain. , 1994, Pediatrics.

[10]  G. Koren,et al.  Effect of neonatal circumcision on pain responses during vaccination in boys , 1995, The Lancet.

[11]  H. Stang,et al.  Circumcision practice patterns in the United States. , 1998, Pediatrics.

[12]  S. Dixon,et al.  Behavioral Effects of Circumcision with and without Anesthesia , 1984, Journal of developmental and behavioral pediatrics : JDBP.

[13]  R. Miller,et al.  Neonatal pain cries: effect of circumcision on acoustic features and perceived urgency. , 1986, Child development.

[14]  E. Bruck.  Sucrose as an analgesic for newborn infants. , 1991, Pediatrics.

[15]  S B Boxerman,et al.  Circumcision: II. Effects upon mother-infant interaction. , 1982, Early human development.

[16]  Gideon Koren,et al.  Effect of neonatal circumcision on pain response during subsequent routine vaccination , 1997, The Lancet.

[17]  M. Klauber,et al.  Regional Anesthesia During Newborn Circumcision , 1983, Clinical pediatrics.

[18]  N. Schechter,et al.  A comparison of the Mogen and Gomco clamps in combination with dorsal penile nerve block in minimizing the pain of neonatal circumcision. , 1999, Pediatrics.

[19]  A L Masciello,et al.  Anesthesia for Neonatal Circumcision: Local Anesthesia is Better Than Dorsal Penile Nerve Block , 1990, Obstetrics and gynecology.

[20]  M. Gunnar,et al.  Beyond dorsal penile nerve block: a more humane circumcision. , 1997, Pediatrics.