Timing for maximum anaesthetic effect of topical cream during early infant circumcision (EIC) in Rakai, Uganda

Area of Science:

• Pediatric Surgery
• Anesthesiology
• Public Health

Background:

• Infant circumcision is a common procedure with varying anesthetic protocols.
• Topical anesthesia is preferred for device-based circumcisions to minimize pain and improve safety.
• Determining optimal timing for topical anesthetic effect is crucial for efficient and effective procedures.

Purpose of the Study:

• To determine the optimal timing for achieving effective topical anesthesia for device-based infant circumcision.
• To evaluate the onset and duration of EMLA cream's anesthetic effect in infants undergoing circumcision.
• To inform best practices for waiting times in mass device-based infant circumcision programs.

Main Methods:

• A field study involving 200 infants aged 0-60 days in Uganda.
• Application of EMLA cream to the foreskin and penile shaft, with anesthetic effect assessed every 5 minutes using the Neonatal Infant Pain Scale (NIPS).
• Evaluation of anesthesia onset, duration, and maximum effect relative to the recommended 60-minute waiting time.

Main Results:

• Topical anesthesia was achieved in at least 25 minutes and lasted 20-30 minutes.
• Maximum anesthesia was achieved in at least 30 minutes but lasted only up to 10 minutes, with reduced effectiveness in infants over 45 days old.
• Anesthetic effect peaked before the recommended 60-minute waiting period and varied with infant age.

Conclusions:

• The optimal timing for maximum topical anesthesia is significantly less than the currently recommended 60 minutes.
• A shorter waiting time for device-based circumcision under topical anesthesia can enhance efficiency, particularly for mass procedures.
• Age influences the response to topical anesthesia, suggesting potential age-specific adjustments may be beneficial.