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Lidocaine-prilocaine cream for analgesia during circumcision in newborn boys

  • Review
  • Intervention

Authors

  • Anna Taddio,

    1. Hospital for Sick Children Research Institute, Graduate Department of Pharmaceutical Sciences, Toronto, Ontario, Canada
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  • Arne Ohlsson,

    Corresponding author
    1. University of Toronto, Departments of Paediatrics, Obstetrics and Gynaecology and Health Policy, Management and Evaluation, Warkworh, Ontario, Canada
    • Arne Ohlsson, Departments of Paediatrics, Obstetrics and Gynaecology and Health Policy, Management and Evaluation, University of Toronto, # 14324 County Rd 29, Warkworh, Ontario, K0K 3K0, Canada. aohlsson@mtsinai.on.ca.

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  • Kristina Ohlsson

    1. University of Toronto, c/o Dr Arne Ohlsson Departments of Paediatrics, Obstetrics and Gynaecology and Health Policy, Management and Evaluation, Warkworth, Ontario, Canada
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Abstract

Background

Neonates routinely undergo tissue-damaging interventions as part of medical treatment. The skin is the site of noxious stimulation for many procedures, including circumcision. EMLA (eutectic mixture of local anesthetics) penetrates intact skin and has the potential to reduce pain associated with circumcision.

Objectives

To determine the effectiveness of EMLA compared to placebo or no treatment as an analgesic for circumcision in male newborns.

Search methods

The guidelines of the Cochrane Neonatal Review Group were followed. No language restrictions were applied. Three reviewers (AT, KO, AO) agreed through a consensus process on the inclusion of a specific study.

Selection criteria

Randomized controlled trials assessing the efficacy/effectiveness of EMLA to prevent circumcision associated pain. Behavioral and physiological outcome data were accepted for efficacy/effectiveness.

Data collection and analysis

Data abstracted from each report included gestational age at birth, timing and dosage regimen of EMLA, control group treatment and outcomes. Abstracted data were verified by the three investigators (AT, KO, AO).

Main results

During the different stages of the surgical procedure for circumcision, the increase in heart rate was 12 - 27 beats per minute less for the EMLA group compared to placebo. In a single study, neonates treated with EMLA showed a higher oxygen saturation. Although the data from the three studies could not be combined, crying during circumcision was reported as less in the EMLA treated groups. In two studies, facial action was lower in the EMLA treated groups compared to placebo.

Authors' conclusions

EMLA reduces pain response during circumcision in newborn male infants. Other potentially more effective forms of analgesia for circumcision (such as dorsal penile nerve block, ring block) should be subjected to systematic reviews.

摘要

背景

Lidocaineprilocaine軟膏用於新生男嬰割包皮止痛之用

新生兒常常接受傷害組織的醫療行為;皮膚通常是最常接受刺激的地方,包含割包皮。EMLA(局部麻醉劑的混合物)可以穿透完整的皮膚,可能有減少割包皮所產生疼痛的效果。

目標

比較新生男嬰割包皮時使用EMLA和安慰組或是沒有使用麻醉劑的有效性。

搜尋策略

使用Cochrane Neonatal Review Group的標準,沒有特殊的語言限制,三位檢閱者 (AT, KO, AO) 經由開會來同意所包含的研究。

選擇標準

評估使用EMLA用於減輕包皮切除術疼痛之效力/有效性 (efficacy/effectiveness) 的臨床隨機試驗。利用行為及生理的結果來評估效力/有效性可被接受。

資料收集與分析

三位檢閱者 (AT, KO, AO) 查閱每個研究報告中個案的出生週數、使用EMLA的時機及劑量、EMLA的成分以及對照組治療和結果。

主要結論

在割包皮手術的不同階段,使用EMLA組比安慰組心跳每分鐘上升平均少12 – 27下,在某個單一研究中,使用EMLA的新生兒有較高的血氧濃度。雖然這三個研究無法合而為一,但是使用EMLA組的嬰兒哭泣時間比較短。其中兩個研究中,使用EMLA組的嬰兒臉部的表情較安慰組和緩。

作者結論

EMLA可以減少男嬰割包皮的疼痛,其他割包皮時可能更有效的麻醉方式 (例如陰莖背部神經阻斷術、環狀神經阻斷術) 也應該進行系統的研究。

翻譯人

本摘要由馬偕醫院蕭玥玲翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

單次使用lidocaineprilocaine軟膏 (EMLA) 是安全的且可以有效減少割包皮的疼痛。EMLA軟膏是局部麻醉藥的混合物,它為小孩及成人提供了在進行疼痛的處置時可靠的麻醉效果,副作用侷限於包括局部的皮膚反應像是發紅,但是使用在新生兒尤其是早產兒是有所疑慮。審核之前的研究發現使用單一劑量EMLA可以減少男嬰割包皮的疼痛且不會造成嚴重的副作用,EMLA並不能被推薦認為優於其他的止痛法,像是使用lidocaine做局部神經阻斷。

Plain language summary

Lidocaine-prilocaine cream for analgesia during circumcision in newborn boys

A single dose of lidocaine-prilocaine cream (EMLA) is safe and lessens the pain of circumcision.EMLA cream includes a mixture of local anaesthetics. It provides reliable anaesthesia for painful procedures in children and adults. Adverse effects have been limited to temporary local skin reactions such as redness. There have been concerns, though, about whether it would be safe for newborns, especially those born too early (preterm). The review of trials found that EMLA cream lessens pain during circumcision of newborn males, without serious adverse effects from single doses. EMLA cannot be recommended over other proven pain relief, such as regional nerve block with lidocaine.

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