TOPICAL ANESTHESIA DURING CIRCUMCISION IN NEWBORN-INFANTS

Objective.-To determine the efficacy of topical anesthetic cream, eutectic mixture of local anesthetics (EMLA), in alleviating pain from neonatal circumcision. Design.-Randomized, controlled trial. Setting.-Normal newborn nursery in a university teaching hospital. Patients.-Twenty-seven newborn, full-term male neonates, aged 1 to 3 days. Outcome Measures.-Heart rate, transcutaneous oxygen saturation, facial activity, and crying. Results.-Compared with baseline, all newborns experienced pain as evidenced by increased heart rate of an average of 40 beats per minute (F [8, 25]=14.12; P<.0001), decreased oxygen saturation of 3% (F [8, 25]=15.02; P<.0001), and more facial actions indicative of pain (F [8, 25]=5.25; P<.002) during all phases of the procedure. Compared with placebo, EMLA significantly attenuated the pain response as shown by lower heart rate of an average of 25 beats per minute (F [1, 25]=14.92; P<.001), higher oxygen saturation of 5%, particularly during the clamping and lysis phases (F [1, 25]=19.83; P<.0001), 20% less facial activity (F [1, 25]=12.01; P<.002), and 15% less crying during the clamping, Gomco clamp application, and incision of the foreskin. There were no differences between groups in the spectral crying parameters. Conclusions.-Circumcision procedure produces pain responses that EMLA diminishes. Thus, EMLA may be a useful agent for pain management in neonatal circumcision.