Comparison of pain response during neonatal circumcision with or without a topical anaesthetic formulation in an urban hospital in Jos, Nigeria

Abstract

Background: Circumcision is the commonest surgical procedure performed in male neonates, usually without anaesthesia. Recent research had shown that new-borns have the anatomical and functional components required for perception of painful stimuli, and that unmanaged pain can have long-lasting effects on neurological function. A topical application of eutectic mixture of local anaesthetics (EMLA) has been shown to be a safe and effective method of pain control during neonatal circumcision. Objective: To determine whether topical anaesthesia (EMLA) decreases pain response during neonatal circumcision, with the overall purpose of recommending its use in Hospitals. Methods: This was a randomized, double blind intervention study that compared pain scores between neonates who had circumcision with or without topical anaesthesia. Neonates were randomly assigned to either treatment or control group. A full physical examination was done, with weight, heart rate, respiratory rate, oxygen saturation measured before and after the circumcision. Acute behavioural pain response was quantified using the Neonatal Infant pain scale [NIPS] and results compared between the two groups. Results: The mean age of the neonates in the study was 12 ±2 days. The mean of the weight for the intervention group was 3.7±0.5kg and that of the control group was 3.6±0.7kg. Also the mean of the head circumference in the intervention group was 38.4±0.3cm and that of the control group was 38.5±0.2cm. The mean of the length in the intervention group was 53.4±0.3cm and that of the control group was 53.3±0.7cm. The control and the intervention group were similar with regards to the physical characteristics. Neonates who had topical anaesthesia before circumcision had statistically, significant lower mean NIPS score compared to the control group (4.56 ±0.9 versus 5.94 ±0.2), P = 0.001. Also, they had smaller decreases in transcutaneous oxygen levels, from 96.11±1.8 to 93.3±3.2, compared to the control group, from 95.97±1.8 to 89.83±2.2. They also had smaller increases in heart rate compared to the control group, from 139.67±5.4 to 142.19±3.6 beats per minute versus, from 139.42±5.26 to 152.3±6.3 beats per minute; and respiratory rates, from 48.22±1.9 to 49.1±3.0 compared to from 48.28±1.9 to 53.2±2.9 in the control group. Conclusion: Neonates receiving topical anaesthesia before the circumcision experienced significantly less pain, smaller decreases in transcutaneous oxygen levels, smaller increases in heart rate and respiratory rate than controls.