RT Journal Article
SR Electronic
T1 Comparison of dorsal penile nerve block alone and in combination with lidocaine–prilocaine cream in neonates undergoing circumcision: a randomized controlled study
JF World Journal of Pediatric Surgery
JO World Jnl Ped Surgery
FD BMJ Publishing Group Ltd
SP e000470
DO 10.1136/wjps-2022-000470
VO 5
IS 4
A1 Ogundele, Ibukunolu Olufemi
A1 Nwokoro, Chigbundu Collins
A1 Adedeji, Tewogbade Adeoye
A1 Igwe, Arua Obasi
A1 Adumah, Collins Chijioke
A1 Talabi, Ademola Olusegun
A1 Shonubi, Aderibigbe Modupe
A1 Sowande, Oludayo Adedapo
YR 2022
UL http://wjps.bmj.com/content/5/4/e000470.abstract
AB Background Suboptimal neonatal circumcision analgesia causes a significant stress response. There is continued search for more effective analgesia for neonatal circumcision. We aimed to determine whether lidocaine–prilocaine cream (LPC) prior to dorsal penile nerve block (DPNB) offers better analgesia than DPNB alone.Methods A prospective randomized study of 72 neonates undergoing plastibell circumcision was randomized into two groups of 36 each. Group I received DPNB alone with 4 mg/kg plain lidocaine. Group II had 1 g LPC applied to the phallus 1 hour before DPNB. Serum cortisol levels were measured 30 min preoperatively and 30 min postoperatively. Heart rate (HR) and peripheral arterial oxygen saturation (SpO2) were noted at 30 min preoperatively, after DPNB injection, after excising the prepuce, and at 30 min thereafter. The primary outcome measure was change in serum cortisol levels, while secondary outcomes were changes in HR and SpO2.Results Both groups had increased mean serum cortisol levels, decreased mean SpO2 and increased mean HR from baseline. The rise in mean serum cortisol level was significantly lower in group II (8.09±4.53 µg/dL) than that in group I (11.42±7.83 µg/dL) (p=0.034). Changes in SpO2 and HR were significantly less in group II than that in group I patients (p<0.05), except for HR changes at 30 min after excision of the prepuce (p=0.086).Conclusion These data suggest that neonates who received LPC prior to DPNB experienced significantly less pain from plastibell circumcision than those who had DPNB alone.Trial registration number PACTR201906554747665.All data relevant to the study are included in the article or uploaded as supplementary information.