Woodman P J
Genesys Regional Medical Center, Flint, Michigan, USA.
Obstet Gynecol. 1999 May;93(5 Pt 1):775-9. doi: 10.1016/s0029-7844(98)00499-2.
To evaluate epicutaneous application of 5% lidocaine-prilocaine and 30% lidocaine cream anesthetics for neonatal circumcision.
The efficacy of 5% lidocaine-prilocaine and 30% lidocaine creams was compared in a randomized, double-blind, placebo-controlled trial. Sixty-one neonates were randomly assigned to one of three groups: 5% prilocaine-lidocaine (n = 20), 30% lidocaine (n = 20), and a control group that received an acid-mantle cream (n = 21). Heart rate, oxygen saturation, and crying time were monitored before, during, and after circumcision. Blood pressure was measured before and after circumcision.
Mean peak heart rates for the 5% lidocaine-prilocaine, 30% lidocaine, and control groups (+/- standard deviation) were 146 +/- 16, 157 +/- 10, and 164 +/- 16 beats per minute, respectively. During four of six active phases of circumcision, the 5% lidocaine-prilocaine group suppressed significant increases in heart rate better than 30% lidocaine, which was more effective than control (dorsal clamp, P < .001; bell clamp on, P = .001; tightening, P = .001; bell clamp off, P < .001). During tightening of the bell clamp, significantly less crying was seen in the 5% lidocaine-prilocaine group (13 +/- 12 seconds) compared with 30% lidocaine (24 +/- 14 seconds) and controls (38 +/- 27 seconds) (P < .001). The group that received 5% lidocaine-prilocaine also had no significant increase in systolic (t = 1.6, P = .12) or diastolic (t = 1.9, P = .067, respectively) blood pressure, unlike the group receiving 30% lidocaine (t = 4.8, P = .001 and t = 2.9, P = .009, respectively) and the placebo group (t = 2.5, P = .023 and t = 2.3, P = .032). There were no significant differences in oxygen saturation (alpha = .05, power 0.79).
Epicutaneous 5% lidocaine-prilocaine was more effective than 30% lidocaine for neonatal circumcision, better reducing neonatal stress indicators. Lidocaine-prilocaine significantly shortened crying time during one of the most painful phases of circumcision. Both topical anesthetics were more effective than placebo in attenuating the behavioral and physiologic indicators of neonatal pain.
评估5%利多卡因-丙胺卡因和30%利多卡因乳膏用于新生儿包皮环切术的经皮应用效果。
在一项随机、双盲、安慰剂对照试验中比较5%利多卡因-丙胺卡因和30%利多卡因乳膏的疗效。61例新生儿被随机分为三组之一：5%丙胺卡因-利多卡因组（n = 20）、30%利多卡因组（n = 20）和接受酸性保护膜乳膏的对照组（n = 21）。在包皮环切术前、术中及术后监测心率、血氧饱和度和哭闹时间。在包皮环切术前和术后测量血压。
5%利多卡因-丙胺卡因组、30%利多卡因组和对照组的平均心率峰值（±标准差）分别为每分钟146±16次、157±10次和164±16次。在包皮环切术的六个活跃阶段中的四个阶段，5%利多卡因-丙胺卡因组比30%利多卡因组更能有效抑制心率的显著增加，30%利多卡因组比对照组更有效（背侧夹闭，P <.001；钟形夹开启，P =.001；收紧，P =.001；钟形夹关闭，P <.001）。在收紧钟形夹时，5%利多卡因-丙胺卡因组的哭闹时间（13±12秒）明显少于30%利多卡因组（24±14秒）和对照组（38±27秒）（P <.001）。与接受30%利多卡因的组（收缩压t = 4.8，P =.001；舒张压t = 2.9，P =.009）和安慰剂组（收缩压t = 2.5，P =.023；舒张压t = 2.3，P =.032）不同，接受5%利多卡因-丙胺卡因的组收缩压（t = 1.6，P =.12）或舒张压（t = 1.9，P =.067）均无显著升高。血氧饱和度无显著差异（α =.05，检验效能0.79）。
对于新生儿包皮环切术，经皮应用5%利多卡因-丙胺卡因比30%利多卡因更有效，能更好地降低新生儿应激指标。利多卡因-丙胺卡因在包皮环切术最疼痛阶段之一显著缩短了哭闹时间。两种局部麻醉药在减轻新生儿疼痛的行为和生理指标方面均比安慰剂更有效。
