Regional anesthesia during newborn circumcision. Effect on infant pain response
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Dorsal penile nerve block (DPNB) with lidocaine significantly reduces pain and crying during newborn circumcision. This regional anesthesia technique is safe and effective for minimizing infant distress during the procedure.
Area of Science:
- Pediatric Anesthesiology
- Neonatal Surgery
- Pain Management
Background:
- Newborn circumcision is a common procedure associated with pain and distress.
- Effective pain management strategies are crucial for neonatal well-being during circumcision.
Purpose of the Study:
- To evaluate the efficacy of dorsal penile nerve block (DPNB) with lidocaine in reducing pain and behavioral distress during newborn circumcision.
Main Methods:
- A controlled, double-blind study involving three groups of infants: DPNB with lidocaine, DPNB with saline (control), and no DPNB (control).
- Pain and distress were assessed via subjective observation, heart rate monitoring, and percentage of time crying.
- Data collected across six sequential timed intervals during circumcision.
Main Results:
- Ninety-three percent of infants receiving lidocaine showed decreased agitation post-anesthetic.
- The lidocaine group exhibited at least a 50% lower mean heart rate increase compared to controls (p < 0.01).
- Infants receiving DPNB with lidocaine cried 50% less than combined controls (p < 0.01).
Conclusions:
- Dorsal penile nerve block with lidocaine is an effective method for minimizing pain and distress in newborns undergoing circumcision.
- The DPNB technique is easily administered and associated with no significant complications.
- Neonatal circumcision procedures can benefit from the implementation of DPNB with lidocaine for improved infant pain management.
Abstract:
A controlled, double-blind investigation was undertaken to determine whether regional anesthesia by dorsal penile nerve block (DPNB) could effectively minimize the pain and behavioral disruptions usually associated with newborn circumcision. Fifteen infants had DPNB with lidocaine, eight control infants had DPNB with saline, and eight additional control infants were circumcised without undergoing DPNB. Newborn distress was gauged by subjective observation, measurement of heart rate, and the percent of time spent crying in six sequential timed intervals during circumcision. Ninety-three percent of subjects who received lidocaine were observed to have a decrease in agitation after anesthetic administration. The mean increase in heart rate during circumcision was at least 50 percent less in the lidocaine injected group than in either control group (p less than 0.01). Infants who had DPNB with lidocaine cried 50 percent less during circumcision compared to combined controls (p less than 0.01). DPNB was easily administered, and there were no significant complications. Physicians who circumcise newborns have good reason to employ the technique of dorsal penile nerve block with lidocaine to minimize infant pain and distress.