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Franca Benini, MD; C. Celeste Johnston, RN, DEd; Daniel Faucher, MD, FRCPC; J. V. Aranda, MD, PhD, FRCPC

JAMA. 1993;270(7):850-853.

Abstract
Objective.
—To determine the efficacy of topical anesthetic cream, eutectic mixture of local anesthetics (EMLA), in alleviating pain from neonatal circumcision.

Design.
—Randomized, controlled trial.

Setting.
—Normal newborn nursery in a university teaching hospital.

Patients.
—Twenty-seven newborn, full-term male neonates, aged 1 to 3 days.

Outcome Measures.
—Heart rate, transcutaneous oxygen saturation, facial activity, and crying.

Results.
—Compared with baseline, all newborns experienced pain as evidenced by increased heart rate of an average of 40 beats per minute (F [8, 25]=14.12; P<.0001), decreased oxygen saturation of 3% (F [8, 25]=15.02; P<.0001), and more facial actions indicative of pain (F [8, 25]=5.25; P<.002) during all phases of the procedure. Compared with placebo, EMLA significantly attenuated the pain response as shown by lower heart rate of an average of 25 beats per minute (F [1, 25]=14.92; P<.001), higher oxygen saturation of 5%, particularly during the clamping and lysis phases (F [1, 25]=19.83; P<.0001), 20% less facial activity (F [1, 25]=12.01; P<.002), and 15% less crying during the clamping, Gomco clamp application, and incision of the foreskin. There were no differences between groups in the spectral crying parameters.

Conclusions.
—Circumcision procedure produces pain responses that EMLA diminishes. Thus, EMLA may be a useful agent for pain management in neonatal circumcision.

(JAMA. 1993;270:850-853)

Author Affiliations
From the Division of Nursing Research and Developmental Pharmacology and Perinatal Research Unit, McGill University—Montreal Children's Hospital Research Institute, Montreal, Quebec. Dr Benini is currently with the Department of Neonatology, University of Padua (Italy).

Footnotes
Reprint requests to McGill University, 3506 University St, Montreal, Quebec, Canada H3A 2A7 (Dr Johnston).

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