Lidocaine-prilocaine cream for analgesia during circumcision in newborn boys

Taddio A, Ohlsson A, Ohlsson K

Published Online:

January 21, 2009

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.

Abstract (click to read)

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 strategy:

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.

This record should be cited as:

Taddio A, Ohlsson A, Ohlsson K. Lidocaine-prilocaine cream for analgesia during circumcision in newborn boys. Cochrane Database of Systematic Reviews 1999, Issue 3. Art. No.: CD000496. DOI: 10.1002/14651858.CD000496

Assessed as up to date:

May 17, 1999

Find the research

Get full text at The Cochrane Library

Primary Review Group:

Neonatal Group

Health topics:

Neonatal care > Pain control

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Lidocaine-prilocaine cream for analgesia during circumcision in newborn boys

More like this

Copyright © 2011 - The Cochrane Collaboration