Effect of lidocaine-prilocaine eutectic mixture of local anaesthetic cream compared with oral sucrose or both in alleviating pain in neonatal circumcision procedure

Abstract

Background: Neonatal circumcision is one of the oldest and most  frequently performed surgical procedures on males. Newborns demonstrate strong endogenous reaction to pain and therefore modalities are being explored for optimum pain relief during circumcision. Pediatric nurses have a vital role for the use of these modalities and minimising the pain  response during the neonatal minor procedures.

Aim: The aim of this study was to assess the effectiveness of eutectic mixture of local anaesthetic (EMLA) cream compared with oral sucrose and both in alleviating pain in neonatal circumcision.

Materials and Methods: This study was conducted in the Day Care Surgery Department of Maternity and Children Hospital, Dammam City, KSA. 90 full-term newborn males who underwent circumcision were divided randomly into three groups (30 each). Each group was assigned to receive a different type of analgesics such as EMLA cream (Group A), oral sucrose (Group B)  or combination of EMLA cream and oral sucrose (Group C). Neonatal
pain agitation and sedation scale (N-PASS) was used 5 min before, during and 5 min after the circumcision procedure to assess the neonatal response to pain.

Results: N-PASS scores were signifi cantly lower in Group C (median Group C = 5.2, Group A = 5.8, Group B = 8.5; P< 0.001). The endogenous  response to pain in terms of escalation of heart rate and reduction in O2 saturation were minimal among Group C (P < 0.0001). Duration of crying was comparable among all the groups. 

Conclusion: The combination of sucrose and EMLA cream revealed a higher analgesic effect and minimal adverse response to pain than either EMLA
cream or sucrose alone during neonatal circumcision.

Key words: Eutectic mixture of local anaesthetic, neonatal circumcision, neonatal pain agitation and sedation scale score, pain, sucrose