Kiboneka Stephen, Anok Aggrey, Nakabuye Regina, Odiya Silas, Magembe Julius, Nazziwa Rose, Ddamulira Charles, Mulooki Andrew, Galiwango Ronald Moses, Watya Stephen, Li Philip S, Lee Richard K, Gray Ronald H, Kigozi Godfrey, Kankaka Edward Nelson
Rakai Health Sciences Program Kalisizo Uganda.
Weill Cornell Medicine of Cornell University New York New York USA.
BJUI Compass. 2023 Jan 16;4(4):423-429. doi: 10.1002/bco2.223. eCollection 2023 Jul.
The objective of this study is to determine the optimal timing for device-based infant circumcision under topical anaesthesia.
SUBJECTS/PATIENTS: We include infants aged 1-60 days who were enrolled in a field study of the no-flip ShangRing device at four hospitals in the Rakai region of south-central Uganda, between 5 February 2020 and 27 October 2020.
Two hundred infants, aged 0-60 days, were enrolled, and EMLA cream was applied on the foreskin and entire penile shaft. The anaesthetic effect was assessed every 5 min by gentle application of artery forceps at the tip of the foreskin, starting at 10 min post-application until 60 min, the recommended time to start circumcision. The response was measured using the Neonatal Infant Pain Scale (NIPS). We determined the onset and duration of anaesthesia (defined as <20% of infants with NIPS score >4) and maximum anaesthesia (defined as <20% of infants with NIPS score >2).
Overall, NIPS scores decreased to a minimum and reversed before the recommended 60 min. Baseline response varied with age, with minimal response among infants aged 40 days. Overall, anaesthesia was achieved after at least 25 min and lasted 20-30 min. Maximum anaesthesia was achieved after at least 30 min (except among those aged >45 days where it was not achieved) and lasted up to 10 min.
The optimal timing for maximum topical anaesthesia occurred before the recommended 60 min of waiting time. A shorter waiting time and speed may be efficient for mass device-based circumcision.
本研究的目的是确定局部麻醉下基于器械的婴儿包皮环切术的最佳时机。
受试者/患者：我们纳入了2020年2月5日至2020年10月27日期间在乌干达中南部拉凯地区四家医院参与无翻转商环器械实地研究的1至60日龄婴儿。
招募了200名0至60日龄的婴儿，在包皮和整个阴茎体上涂抹复方利多卡因凝胶。从涂抹后10分钟开始，每隔5分钟通过在包皮尖端轻轻应用动脉钳来评估麻醉效果，直至60分钟，即推荐的开始包皮环切术的时间。使用新生儿婴儿疼痛量表（NIPS）测量反应。我们确定了麻醉的起效时间和持续时间（定义为NIPS评分>4的婴儿<20%）以及最大麻醉效果（定义为NIPS评分>2的婴儿<20%）。
总体而言，NIPS评分在推荐的60分钟之前降至最低并出现反转。基线反应随年龄而异，40日龄婴儿的反应最小。总体而言，至少25分钟后实现麻醉，持续20至30分钟。至少30分钟后达到最大麻醉效果（45日龄以上婴儿未达到），持续长达10分钟。
最大局部麻醉的最佳时机出现在推荐的60分钟等待时间之前。较短的等待时间和速度对于大规模基于器械的包皮环切术可能是有效的。
