Topical anesthesia in preterm neonate: a reflection on the underutilization in clinical practice

Area of Science:

• Neonatal care and pain management
• Pharmacology and anesthesiology

Background:

• Premature neonates in NICUs undergo frequent, painful procedures for clinical stability.
• Topical anesthesia offers a non-systemic option for mild to moderate pain relief.
• Eutectic mixture of local anesthetics (EMLA® cream) is a common topical anesthetic in Brazil.

Purpose of the Study:

• To evaluate the efficacy of topical anesthesia for painful procedures in neonates.
• To address conflicting conclusions in existing literature regarding neonatal topical anesthesia.
• To explore the potential risk of methemoglobinemia associated with topical anesthetic use in neonates.

Main Methods:

• Review of existing literature on topical anesthesia for neonatal procedures.
• Analysis of studies considering direct pain evaluation to reduce methodological bias.
• Comparison of efficacy across different procedures and methodologies.

Main Results:

• Efficacy of topical anesthesia is established for children and adults in cutaneous procedures.
• Studies in neonates show varied conclusions, influenced by procedure type and methodology.
• Potential risk of methemoglobinemia requires careful consideration in neonatal application.

Conclusions:

• Topical anesthesia is a viable option for mild to moderate pain during neonatal procedures like punctures and catheter insertions.
• Direct pain evaluation methods are crucial for more accurate efficacy assessment and comparison.
• Further research is needed to standardize methodologies and confirm safety, particularly regarding methemoglobinemia risk.