Butler-O'Hara M, LeMoine C, Guillet R
Department of Pediatrics, Division of Neonatology, University of Rochester, Rochester, NY 14642, USA.
Pediatrics. 1998 Apr;101(4):E5. doi: 10.1542/peds.101.4.e5.
To compare the efficacy of the dorsal penile nerve block (DPNB) with a less invasive form of local anesthesia, eutectic mixture of local anesthetic (EMLA) cream, for reduction of pain during neonatal circumcision.
Prospective, blinded, randomized, controlled trial.
Tertiary referral, neonatal intensive care nursery in a university teaching hospital.
Fifty infants >/=341/2 weeks postmenstrual age and stable for discharge at time of circumcision; gestational age at birth 25 to 41 weeks; birth weight 600 to 4390 g; age at study 3 to 105 days. An additional cohort of term newborns (n = 20), who were not randomized, were circumcised without anesthesia.
Administration of either EMLA cream (0.5 g topically 1 hour before circumcision) or 1% lidocaine (0.7-1.0 mL subcutaneously 3 minutes before circumcision).
Primary: Neonatal Infant Pain Scale (NIPS) score; secondary: heart rate, respiratory rate. All outcome measures were assessed by an individual who was blinded to the group assignment and did not perform the circumcision.
NIPS scores were significantly lower in the DPNB infants (2.3 +/- 1.8) compared with the EMLA infants (4.8 +/- 0.7). NIPS scores in patients circumcised without anesthesia indicated severe pain. There was a significantly greater increase in heart rate over the duration of the circumcision in the EMLA group than in the DPNB group (49 vs 9 beats per minute). Adverse effects included small hematomas at the site of injection in DPNB infants (10/23), mild erythema at 1 and/or 24 hours after circumcision in the EMLA infants (3/21), and penile edema noted 5 days after circumcision requiring removal of the circumcision bell in 1 DPNB infant.
DPNB provides better pain reduction during neonatal circumcision than EMLA cream. EMLA cream may provide pain reduction compared with no anesthesia during neonatal circumcision.
比较阴茎背神经阻滞（DPNB）与侵入性较小的局部麻醉形式——复方利多卡因乳膏（EMLA）在减轻新生儿包皮环切术疼痛方面的疗效。
前瞻性、盲法、随机对照试验。
大学教学医院的三级转诊新生儿重症监护病房。
50例月经龄≥34.5周且包皮环切术时病情稳定可出院的婴儿；出生时胎龄25至41周；出生体重600至4390克；研究时年龄3至105天。另外一组未随机分组的足月儿（n = 20）在未麻醉的情况下接受包皮环切术。
术前1小时局部涂抹0.5克EMLA乳膏或术前3分钟皮下注射1%利多卡因0.7 - 1.0毫升。
主要指标：新生儿婴儿疼痛量表（NIPS）评分；次要指标：心率、呼吸频率。所有观察指标由对分组情况不知情且未实施包皮环切术的人员进行评估。
DPNB组婴儿的NIPS评分（2.3±1.8）显著低于EMLA组婴儿（4.8±0.7）。未麻醉进行包皮环切术患者的NIPS评分表明存在严重疼痛。EMLA组在包皮环切术过程中心率增加幅度显著大于DPNB组（每分钟49次对9次）。不良反应包括DPNB组婴儿注射部位出现小血肿（10/23），EMLA组婴儿包皮环切术后1小时和/或24小时出现轻度红斑（3/21），以及1例DPNB组婴儿包皮环切术后5天出现阴茎水肿，需拆除包皮环切环。
DPNB在新生儿包皮环切术中减轻疼痛的效果优于EMLA乳膏。与新生儿包皮环切术时不使用麻醉相比，EMLA乳膏可能减轻疼痛。
