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Effectiveness of 1% lidocaine dorsal penile nerve block in infant circumcision
R M Arnett1, J S Jones, E O Horger
1Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston 29425.
Insights
Lidocaine dorsal penile nerve blocks significantly reduced infant stress during circumcision. The procedure, measured by pulse rate and irritability, showed less distress in infants receiving lidocaine compared to controls.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Neonatal Care
Background:
- Infant circumcision is a common procedure associated with pain and stress.
- Effective pain management is crucial for neonatal well-being during surgical interventions.
Purpose of the Study:
- To evaluate the efficacy of 1% lidocaine dorsal penile nerve blocks in reducing infant stress during circumcision.
- To compare stress responses between infants receiving lidocaine, saline, or no injection.
Main Methods:
- Prospective, controlled, double-blinded study involving 51 infants undergoing circumcision.
- Stress assessment included pulse rate, oxygen saturation, and a 1-6 infant irritability grading scale.
- Groups: 1% lidocaine (n=23), saline solution (n=21), and no injection (n=7).
Main Results:
- Lidocaine group showed no significant pulse rate increase; control groups had an average 28.8% increase (p<0.001).
- Oxygen saturation decreased by 1.0% in the lidocaine group versus 5.6% in controls (p<0.001).
- Physician and nursing evaluations indicated significantly lower infant irritability in the lidocaine group (average scores 2.4-2.3) versus controls (4.2).
Conclusions:
- 1% lidocaine dorsal penile nerve blocks are effective in mitigating physiological and behavioral stress responses in infants undergoing circumcision.
- The use of lidocaine provides a safe and effective method for pain management during neonatal circumcision.
- Dorsal penile nerve block with lidocaine should be considered for routine pain control in infant circumcision procedures.
Abstract:
A prospective, controlled, double-blinded investigation was conducted to evaluate whether infants undergoing circumcisions with 1% lidocaine dorsal penile nerve blocks experienced decreased stress as compared with those receiving saline solution injections or no injections. Stress was measured in terms of pulse rate and oxygen saturation on a pulse oximeter. A subjective grading scale was also developed to measure infant irritability. The total number in the study was 51 with 23 infants in the lidocaine group, 21 in the saline solution group, and 7 in the no injection group. The results of the study revealed an average increase of 28.8% in the pulse rate above baseline for the control infants (p less than 0.001) versus no significant change in the lidocaine group. The average oxygen saturation of the control groups decreased by 5.6% from baseline (p less than 0.001), and that of the lidocaine group decreased by 1.0%, which was not a significant change. The subjective data were gained by using a grading scale of 1 to 6 with 1 being the least irritable infant and 6 being the most irritable infant. The physician evaluation gave an average rating of 4.2 to the control group versus 2.4 for the lidocaine group (p less than 0.001). The nursing evaluation during the procedure gave an average rating of 4.2 to the control group versus 2.3 to the anesthetized group (p less than 0.001). The subjective evaluation of infants before and after the procedure was not significantly different. There were no major complications in any of the groups.