title: Effect of lidocaine-prilocaine eutectic mixture of local anaesthetic cream compared with oral sucrose or both in alleviating pain in neonatal circumcision procedure.
abstract: BACKGROUND
  Neonatal circumcision is one of the oldest and most frequently performed surgical procedures on males. Newborns demonstrate strong endogenous reaction to pain and therefore modalities are being explored for optimum pain relief during circumcision. Pediatric nurses have a vital role for the use of these modalities and minimising the pain response during the neonatal minor procedures.
  
  
  OBJECTIVE
  The aim of this study was to assess the effectiveness of eutectic mixture of local anaesthetic (EMLA) cream compared with oral sucrose and both in alleviating pain in neonatal circumcision.
  
  
  METHODS
  This study was conducted in the Day Care Surgery Department of Maternity and Children Hospital, Dammam City, KSA. 90 full-term newborn males who underwent circumcision were divided randomly into three groups (30 each). Each group was assigned to receive a different type of analgesics such as EMLA cream (Group A), oral sucrose (Group B) or combination of EMLA cream and oral sucrose (Group C). Neonatal pain agitation and sedation scale (N-PASS) was used 5 min before, during and 5 min after the circumcision procedure to assess the neonatal response to pain.
  
  
  RESULTS
  N-PASS scores were significantly lower in Group C (median Group C = 5.2, Group A = 5.8, Group B = 8.5; P< 0.001). The endogenous response to pain in terms of escalation of heart rate and reduction in O 2 saturation were minimal among Group C (P < 0.0001). Duration of crying was comparable among all the groups.
  
  
  CONCLUSIONS
  The combination of sucrose and EMLA cream revealed a higher analgesic effect and minimal adverse response to pain than either EMLA cream or sucrose alone during neonatal circumcision.
authors.forename: Reem
authors.initials: R
authors.lastname: Al Qahtani
authors.forename: Laila Younis
authors.initials: LY
authors.lastname: Abu-Salem
authors.affiliation: Department of Pediatric Surgery, King Fahd Hospital of the University, College of Medicine, University of Dammam, Dammam, KSA, .
authors.forename: Kamalesh
authors.initials: K
authors.lastname: Pal
mesh_terms: D000284:Administration, Oral; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002944:Circumcision, Male / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008012:Lidocaine / Q000008:administration & dosage*; D000077442:Lidocaine, Prilocaine Drug Combination; D008297:Male; D009824:Ointments; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D011318:Prilocaine / Q000008:administration & dosage*; D011446:Prospective Studies; D013395:Sucrose / Q000008:administration & dosage*; D013549:Sweetening Agents / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D000077442:Lidocaine, Prilocaine Drug Combination; D009824:Ointments; D013549:Sweetening Agents; D011318:Prilocaine; D013395:Sucrose; D008012:Lidocaine