TY  - JOUR
T1  - DOrsal penile nerve block vs topical placebo for circumcision in low-birth-weight neonates
AU  - Holliday MA, Pinckert TL, Kiernan SC, Kunos I, Angelus P, Keszler M
Y1  - 1999/05/01
N1  - 10.1001/archpedi.153.5.476
JO  - Archives of Pediatrics & Adolescent Medicine
SP  - 476
EP  - 480
VL  - 153
IS  - 5
N2  - Objective 
    To investigate the efficacy and safety of dorsal penile nerve block (DPNB) and eutectic mixture of lidocaine (EMLA) for palliation of pain associated with circumcision in low-birth-weight infants.Design 
    Randomized, blinded, controlled trial.Setting 
    Intensive care nursery (step down unit) at Georgetown University Medical Center, Washington, DC.Participants 
    Fifty neonates with weights of 1600 to 2500 g at the time of circumcision who were discharged from the hospital between May 1994 and June 1995 were randomly assigned to the DPNB, EMLA, or control group. Twenty-five infants who were otherwise eligible were excluded because of parental refusal of consent to participate.Interventions 
    Infants in the DPNB and EMLA groups received anesthesia with subcutaneous injection of 1% lidocaine hydrochloride or topical EMLA, respectively. The control group received sham anesthesia with topical placebo (acid mantle cream).Main Outcome Measures 
    Changes in physiologic variables (heart rate, blood pressure, oxygen saturation, and respiratory rate) and behavioral score 20 minutes before, during, and 5 and 20 minutes after circumcision between DPNB and control groups. Surgical complications and adverse effects were also monitored.Results 
    Fifty infants were enrolled in the study: 19 randomized to the DPNB group, 19 to the control group, and 12 to the EMLA group. Enrollment into the EMLA group was suspended early because of redness and blistering of the foreskin in 2 infants, and this entire group was excluded from further analysis. The clinical course was similar in all groups of infants. All circumcisions were performed without complication or technical difficulty. Statistically significant differences were noted in heart rate, respiratory rate, and behavioral score when comparing the DPNB group with controls during and after circumcision.Conclusion 
    Dorsal penile nerve block is safe and effective in controlling pain associated with circumcision in low-birth-weight infants.
SN  - 1072-4710
M3  - doi: 10.1001/archpedi.153.5.476
UR  - http://dx.doi.org/10.1001/archpedi.153.5.476
ER  -