Comparison of the efficacy of eutectic mixture of local anesthetics (EMLA) and dorsal penile nerve block (DPNB) in neonatal circumcision.

Abstract

Neonates feel pain. There is a concern among practitioners that pain of injecting analgesics to neonates prior to circumcision could as well be the same as the pain of the procedure. This has made many reluctant to offer effective analgesia for circumcision. If eutectic mixture of local anesthetics (EMLA) provides analgesia comparable to dorsal penile nerve block (DPNB), it will obviate needle prick and encourage analgesia use in neonatal circumcision. To determine how the analgesic efficacy of EMLA compares with that of DPNB in neonatal plastibell circumcision. A prospective study of 110 male neonates for plastibell circumcision randomized into two groups: A and B, of 55 each, received EMLA or DPNB as analgesia prior to circumcision, respectively. The pulse rates and SpO2 were recorded with pulse oximeter pre-procedural and at four stages of the procedure (adhesiolysis, dorsal slit, tying, and excision) for each neonate. Also the modification of neonatal infant pain scale (NIPS) was recorded during the procedure. There were differential changes in SpO2 (lower absolute mean values) and pulse rate (higher absolute mean values) for neonates who received EMLA when compared with DPNB before the procedure. These differences were significant with SpO2 at adhesiolysis (91.0% and 95.0%), dorsal slitting (90.9% and 94.7%), and excision stages (93.4% and 95.3), respectively (P < 0.05). They were also significant with the pulse rates at adhesiolysis (167.9 and 158.6), dorsal slitting (174.3 and 161.7), and tying stages (182.2 and 169.0), respectively (P values = 0.013, 0.015, and 0.044, respectively). This shows DPNB is better than EMLA. However, the difference was not significant at the tying stage with SpO2 and at excision stage with PR (P > 0.05). EMLA produces analgesic effect. However, it does not provide effective analgesia for plastibell circumcision in neonates. DPNB provides a better analgesia than EMLA for neonatal plastibell circumcision.