Comparison of dorsal penile nerve block alone and in combination with lidocaine-prilocaine cream in neonates undergoing circumcision: a randomized controlled study.

Autor: Ogundele IO; Department of Surgery, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria., Nwokoro CC; Department of Surgery, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria., Adedeji TA; Department of Chemical Pathology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria., Igwe AO; Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria., Adumah CC; Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria., Talabi AO; Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria., Shonubi AM; Department of Surgery, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria., Sowande OA; Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.
Jazyk: angličtina
Zdroj: World journal of pediatric surgery [World J Pediatr Surg] 2022 Nov 17; Vol. 5 (4), pp. e000470. Date of Electronic Publication: 2022 Nov 17 (Print Publication: 2022).
DOI: 10.1136/wjps-2022-000470
Abstrakt: 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 (SpO 2 ) 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 SpO 2 .
Results: Both groups had increased mean serum cortisol levels, decreased mean SpO 2 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 SpO 2 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.
Competing Interests: Competing interests: A full dissertation of this project was presented to the West African College of Surgeons.
(© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze: MEDLINE
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