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Michael A. Holliday, MD; Thomas L. Pinckert, MD; Sharon C. Kiernan, MD; Ildiko Kunos, MD; Pam Angelus, RN, MSN; Martin Keszler, MD

Arch Pediatr Adolesc Med. 1999;153:476-480.

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.

From the Departments of Pediatrics (Drs Holliday, Kiernan, Kunos, and Keszler and Ms Angelus) and Obstetrics-Gynecology (Dr Pinckert), Georgetown University Medical Center, Washington, DC. Dr Holliday is now with the Division of Neonatology, Department of Pediatrics, Pediatrix Medical Group, Inc, Fort Lauderdale, Fla, and Inova Alexandria Hospital, Alexandria, Va. Dr Pinckert is now with the Division of Perinatology, Department of Obstetrics-Gynecology, Shady Grove Hospital, Gaithersburg, Md. Dr Kiernan is now with the Division of Neonatology, Department of Pediatrics, Holy Cross Hospital, Silver Spring, Md.

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