A comparison of anesthetic efficacy between dorsal penile nerve block (DPNB) with lidocaine and eutectic mixture of local anesthetics (EMLA) cream during neonatal circumcision

OBJECTIVE: Circumcision is often performed in neonates and is associated with significant pain. This study was conducted to compare the anesthetic efficacy of two methods of local anaesthesia for neonatal circumcision: topical eutectic mixture of local anesthetics (EMLA) cream and dorsal penile nerve block (DPNB) with lidocaine. METHODS: Male neonates who presented for circumcision and met the eligibility criteria were recruited for the study and were randomly assigned to one of the two methods of anesthesia before the procedure. Anesthetic efficacy was compared by pain assessment during four standardized steps of the procedure (clamping, crushing, tying, and cutting of the foreskin, respectively) using the modified Neonatal Infant Pain Scale (NIPS), changes in transcutaneous oxygen saturation (SpO(2)), heart rate (HR), and preoperative and postoperative salivary cortisol levels. Patients also were evaluated after 24 hours to assess for complications. RESULTS: Totally, 138 babies were recruited. Significantly higher NIPS scores were observed among babies who had EMLA cream during tying (p=0.019) and cutting (p=0.043). The rise in mean HR from baseline was statistically significant throughout the procedure in the EMLA group. In the DPNB group, there was no significant rise in mean HR during crushing (p=0.919) and cutting (p=0.197). There was a significant decrease in mean SpO(2) from baseline in both groups. Salivary cortisol showed significant increase in mean levels in both groups. No significant untoward effects were observed. CONCLUSION: DPNB with lidocaine has a better pain control compared with EMLA cream during neonatal circumcision. Both methods are safe in neonates.