title: Use of a mixture of lignocaine and bupivacaine vs lignocaine alone for male circumcision under local anaesthesia in Rakai, Uganda.
abstract: OBJECTIVE
  To assess self-reported pain control during and after surgery with a mixture of lignocaine and bupivacaine compared with lignocaine alone among male circumcision (MC) service recipients in Rakai, Uganda.
  
  
  METHODS
  The two formulations of local anaesthesia for MC were used alternatively at weekly intervals in 360 patients; 179 received lignocaine alone and 181 received the lignocaine and bupivacaine mixture (LBmix). The proportions of men reporting pain during or after surgery, and the need for additional anaesthesia during surgery were determined for the LBmix vs lignocaine using Poisson adjusted rate ratios (RRs). Characteristics including age, weight, surgeon (medical officer vs clinical officer), surgical method and duration of surgery were compared between the arms using two-sample t-tests and chi-square tests.
  
  
  RESULTS
  Patient and provider characteristics were comparable between the two anaesthetic groups. A higher proportion of patients reported pain during surgery in the lignocaine group (adjusted RR 11.6, 95% confidence interval [CI] 3.5-37.9, P < 0.001), required additional anaesthesia (adjusted RR 4.8, 95% CI 1.4-17.1, P = 0.015), and were more likely to report pain during the immediate postoperative period (adjusted RR 3.4, 95% CI 2.3-5.0, P < 0.001). These differences were particularly marked among patients with MC times longer than the median (adjusted RR 13.4, 95% CI 3.1-57.0, P < 0.001).
  
  
  CONCLUSIONS
  The LBmix significantly reduced pain associated with MC and the need for additional anaesthesia during MC.
authors: Rakai Health Sciences Program, Entebbe, Uganda. gkigozi@rhsp.org
authors: Godfrey
authors: G
authors: Kigozi
authors: Richard
authors: R
authors: Musoke
authors: Margaret
authors: M
authors: Anyokorit
authors: James
authors: J
authors: Nkale
authors: Nehemiah
authors: N
authors: Kighoma
authors: William
authors: W
authors: Ssebanenya
authors: Joshua
authors: J
authors: Mwinike
authors: Stephen
authors: S
authors: Watya
authors: Fred
authors: F
authors: Nalugoda
authors: Joseph
authors: J
authors: Kagaayi
authors: Grace
authors: G
authors: Nalwoga
authors: Gertrude
authors: G
authors: Nakigozi
authors: Noah
authors: N
authors: Kiwanuka
authors: Frederick
authors: F
authors: Makumbi
authors: Tom
authors: T
authors: Lutalo
authors: David
authors: D
authors: Serwadda
authors: Maria
authors: M
authors: Wawer
authors: Ronald
authors: R
authors: Gray
mesh_terms: D000293:Adolescent; D000328:Adult; D019162:Anesthetics, Combined / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D002648:Child; D002944:Circumcision, Male; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D014454:Uganda; D055815:Young Adult
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D008012:Lidocaine; D002045:Bupivacaine