Analgesia for Infant Circumcision: Eutectic Mixture of Local Anesthetic (EMLA) Cream versus Dorsal Penile Nerve Block using Bupivacaine

Abstract

Context

Circumcision is a painful procedure; thus, analgesia for neonatal circumcision is advocated for every male infant, and its use is considered essential by the American Academy of Pediatrics.

Aim

This study aimed to compare the analgesic, hemodynamic effects, and complications of an eutectic mixture of a local anesthetic cream versus dorsal penile nerve block using bupivacaine for infants coming for circumcision.

Materials and Methods

This was a prospective randomized interventional study involving 64 infants scheduled for circumcision at the Jos University Teaching Hospital. Infants were randomized into one of two groups through allocation concealment technique.

• Group I received dorsal penile nerve block with plain bupivacaine 0.5 mL/kg of 0.25%.

• Group II received 1 g of an eutectic mixture of a local anesthetic cream (EMLA).

Circumcision started 5 minutes after penile block for group I and 1 hour after EMLA cream application for group II. Pain levels using CRIES scale, hemodynamic parameters, duration of surgery, and postoperative complications were noted and documented.

Data were analyzed using SPSS version 23. A P value of less than 0.05 was considered statistically significant.

Results

The study groups were comparable in demographic characteristics (P = 0.054). Less infants had CRIES scores of >4 in the DPNB group up to 2 hours postoperative period. Hemodynamic parameters were within normal ranges but higher in the EMLA group. No complication was noted in both study groups.

Conclusion

Dorsal penile nerve block with bupivacaine provided better analgesia in infants undergoing circumcision than EMLA.