Efficacy and Safety of Lidocaine-Prilocaine Cream for Pain During Circumcision

Taddio, Anna; Stevens, Bonnie; Craig, Kenneth D.; Rastogi, Pratap; Ben-David, Shlomit; Shennan, Andrew; Mulligan, Peggy; Koren, Gideon

doi:10.1097/00006254-199710000-00009

Cited by 53 publications

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“…Concerns about methemoglobinemia and prilocaine sensitivity and 28 its inferiority to DPNB 31 and long application time for effectiveness have limited the use of EMLA. Recent reports, 11,13 however, have demonstrated an excellent safety record in small numbers of patients.…”

Section: Discussionmentioning

confidence: 99%

“…The 1989 AAP Task Force on Circumcision 8 recommended additional study on local anesthesia and, in the subsequent 8 years, numerous studies have documented the efficacy and safety of dorsal penile nerve block (DPNB) with lidocaine, 5,9,10 eutectic mixture of local anesthetics (EMLA), [11][12][13] oral sucrose, 14,15 and topical lidocaine. 16 Despite this evidence of anesthesia's benefits and safety, there has been to date little published data on the prevalence of its use.…”

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confidence: 99%

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Circumcision Practice Patterns in the United States

Stang

Snellman

1998

Pediatrics

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ABSTRACT. Objective. To determine 1) the performing of circumcision by medical specialty, gender, and years of practice; 2) the pattern of anesthetic use for this procedure; and 3) the reasons physicians cite for not using anesthesia.Design. A total of 3066 questionnaires were received from a mailing to a representative sampling of physicians stratified by specialty and geographic location.Results. Fifty-eight percent (1768) of the questionnaires were returned and interpretable from the following specialists: pediatricians (PEDs), 73% (n ‫؍‬ 691); family practitioners (FPs), 52% (n ‫؍‬ 464); and obstetricians (OBs), 51% (n ‫؍‬ 623).Of the respondents, 956 (54%) perform at least one circumcision per month (35% of PEDs; 60% of FPs; 70% of OBs). Of the physicians performing circumcisions, 45% use anesthesia (71% of PEDs; 56% of FPs; 25% of OBs). Of physicians using anesthesia, 85% use dorsal penile nerve block.A significantly higher percentage of male physicians (57%) are performing circumcisions than are females (45%), but there was no difference in the percent using anesthesia. Recently trained PEDs and FPs were more likely to use anesthetics than were their older colleagues, but OB use of pain relief was independent of their practice longevity. Physicians in the western states were significantly more likely to use anesthesia than were other physicians from the rest of the United States.Respondents who did not use anesthesia cited "concern over adverse drug effects" (54%) followed by "procedure does not warrant anesthesia" (44%) as the most common explanations.Conclusions. A substantial number of PEDs are performing circumcisions, and they are most likely to use anesthesia (71%), followed by FPs (56%), then OBs (25%). With recent recognition of the importance of pain reduction in neonatal procedures and the lack of substantiated contraindications to newborn anesthetic use, additional education of current practitioners, residents, and parents is required to increase the use of anesthesia for circumcision. Pediatrics 1998;101(6). URL: http://www. pediatrics.org/cgi/content/full/101/6/e5; circumcision, anesthesia for neonatal circumcision.ABBREVIATIONS. AAP, American Academy of Pediatrics; DPNB, dorsal penile nerve block; EMLA, eutectic mixture of local anesthetics; OB, obstetrician; FP, family practitioner; PED, pediatrician.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Circumcision Practice Patterns in the United States

Stang

Snellman

1998

Pediatrics

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“…Adequate convergent validity has been shown by comparing the NFCS with other facial coding systems [10,21]. Evidence in support of the construct validity of NFCS has been established as the scale differentiated infants receiving or not receiving pharmacologic treatment [39]. However, although NFCS was sensitive to different levels of distress in infants over a procedure, it did not distinguish between painrelated and non-pain related distress [1].…”

Section: Infant Behavioural Pain Measuresmentioning

confidence: 99%

Infant Clinical Pain Assessment: Core Behavioral Cues

DiLorenzo

Riddell

Flora

et al. 2018

The Journal of Pain

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2 Highlights NFCS and MBPS coding systems were examined using Confirmatory Factor Analysis.  A revised 3-item NFCS maintained good psychometric properties of 7-item version.  Redefinition of MBPS with cry as a sole indicator was suggested.  The revised scales increase efficiency of coding based on improved psychometrics. AbstractDiverse behavioural cues have been proposed to be useful cues in infant pain assessment, but there is a paucity of evidence based on formal psychometric evaluation to establish their validity for this purpose. We aimed to examine two widely-used coding systems, the Neonatal Facial Coding System (NFCS) and the Modified Behaviour Pain Scale (MBPS), by examining their factor structures with confirmatory factor analysis using a large archival dataset. The results indicated that an item-reduced NFCS scale with three items produced a one-factor pain model that maintained the good psychometric properties of the 7-item scale. In addition, it was found that MBPS also has challenging internal consistency, with items that are both weakly correlated and highly redundant. One-item of the MBPS may be able to capture the construct of pain equally well or potentially improve its psychometric properties. Redefinition of MBPS with cry as a sole indicator was suggested. This analysis provides two new iterations of the NFCS and MBPS that improve construct validity and internal consistency. These shorter versions also improve the feasibility of both measures and increase their potential for clinical use as less time is required for their administration.Perspective: This article presents new iterations of the NFCS and MBPS scales. These revised measures improve the internal consistency of the measures, feasibility of use of the tools in research settings and the efficiency of the coding process. The revised tools could also improve the feasibility of coding within clinical settings.

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“…A total of 48 infants were enrolled in the study and randomized into one of the following four groups: Mϩ (16) …”

Section: Subjectsmentioning

confidence: 99%

“…Since that time, many studies involving thousands of infants have demonstrated the safety and efficacy of this approach. 3,14,15 Other regional anesthesia techniques that have demonstrated some efficacy include topical anesthesia with eutectic mixture of local anesthetics (EMLA) 16,17 and ring block of the penis. 4,18 None of these have been studied as comprehensively as DPNB.…”

mentioning

confidence: 99%

A Comparison of the Mogen and Gomco Clamps in Combination With Dorsal Penile Nerve Block in Minimizing the Pain of Neonatal Circumcision

et al. 1999

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ABSTRACT. Objectives. 1) To compare the Mogen and Gomco clamps with regard to pain experienced during neonatal circumcision, and 2) to assess neonatal circumcision pain with and without dorsal penile nerve block (DPNB).Design/Methods. A randomized, controlled, nonblinded clinical trial; 48 healthy, full-term infants were randomized into one of the following four groups: Gomco vs Mogen with (؉) or without (؊) DPNB. DPNB؉ infants were injected with 0.8 mL of 1% lidocaine before circumcision. DPNB؊ infants received no placebo injection. Heart rate, respiratory rate, and oxygen saturation (SaO 2 ) during the procedure were monitored and data transferred to computer files by using the Datalab software system. Crying was recorded on videotape. Pre-and postcircumcision saliva samples for cortisol analysis were collected. Heart rate, respiratory rate, SaO 2 , cortisol changes, and duration of crying were evaluated statistically with two-way analyses of variance and t tests.Results ABBREVIATIONS. HR, heart rate; RR, respiratory rate; Sao 2 , oxygen saturation; DPNB, dorsal penile nerve block; ANOVA, analysis of variance.

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Efficacy and Safety of Lidocaine-Prilocaine Cream for Pain During Circumcision

Cited by 53 publications

References 0 publications

Circumcision Practice Patterns in the United States

Circumcision Practice Patterns in the United States

Infant Clinical Pain Assessment: Core Behavioral Cues

A Comparison of the Mogen and Gomco Clamps in Combination With Dorsal Penile Nerve Block in Minimizing the Pain of Neonatal Circumcision

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