Lander J, Brady-Fryer B, Metcalfe J B, Nazarali S, Muttitt S
Faculty of Medicine, University of Alberta, Edmonton, Canada.
JAMA. 1997;278(24):2157-62.
Beliefs about the safety and effectiveness of current anesthetics have resulted in many newborns being circumcised without the benefit of anesthesia.
To compare ring block, dorsal penile nerve block, a topical eutectic mixture of local anesthetics (EMLA), and topical placebo when used for neonatal circumcision. The placebo represented current practice, with no anesthetic for neonatal circumcision.
A randomized controlled trial.
Antenatal units in 2 tertiary care hospitals in Edmonton, Alberta.
A consecutive sample of 52 healthy, full-term, male newborns, aged 1 to 3 days.
Physiological and behavioral monitoring occurred in a series of trials: baseline, drug application, preparation, circumcision, and postcircumcision. Surgical procedures defined the following 4 stages of the circumcision: cleansing, separation, clamp on, and clamp off. Methemoglobin level was assessed 6 hours after surgery.
Heart rate, cry, and methemoglobin level.
Newborns in the untreated placebo group exhibited homogeneous responses that consisted of sustained elevation of heart rate and high-pitched cry throughout the circumcision and following. Two newborns in the placebo group became ill following circumcision (choking and apnea). The 3 treatment groups all had significantly less crying and lower heart rates during and following circumcision compared with the untreated group. The ring block was equally effective through all stages of the circumcision, whereas the dorsal penile nerve block and EMLA were not effective during foreskin separation and incision. Methemoglobin levels were highest in the EMLA group, although no newborn required treatment.
The most effective anesthetic is the ring block; EMLA is the least effective. It is our recommendation that an anesthetic should be administered to newborns prior to undergoing circumcision.
对当前麻醉剂安全性和有效性的观念导致许多新生儿在未接受麻醉的情况下接受包皮环切术。
比较环形阻滞、阴茎背神经阻滞、局部麻醉药复方制剂（EMLA）和局部安慰剂用于新生儿包皮环切术的效果。安慰剂代表当前的做法，即新生儿包皮环切术不使用麻醉剂。
一项随机对照试验。
艾伯塔省埃德蒙顿市两家三级护理医院的产前病房。
连续抽取52名1至3日龄的健康足月男婴。
在一系列试验中进行生理和行为监测：基线、用药、准备、包皮环切术和环切术后。外科手术定义了包皮环切术的以下4个阶段：清洗、分离、夹闭和松开。术后6小时评估高铁血红蛋白水平。
心率、哭声和高铁血红蛋白水平。
未治疗的安慰剂组新生儿表现出一致的反应，即在整个包皮环切术及术后心率持续升高且哭声尖锐。安慰剂组有两名新生儿在包皮环切术后生病（窒息和呼吸暂停）。与未治疗组相比，3个治疗组在包皮环切术期间及术后的哭声均明显减少，心率也较低。环形阻滞在包皮环切术的各个阶段均同样有效，而阴茎背神经阻滞和EMLA在包皮分离和切开时无效。EMLA组的高铁血红蛋白水平最高，尽管没有新生儿需要治疗。
最有效的麻醉方法是环形阻滞；EMLA效果最差。我们建议在新生儿进行包皮环切术前应给予麻醉。
