April 23, 1997
Providing pain control for circumcision necessary, safe, and effective
TORONTO - Researchers at The Hospital for Sick Children (SickKids) and Women's College Hospital (WCH) are hoping the results of their study published in the April 24 issue of the New England Journal of Medicine will influence a change in the practice of circumcising male infants without analgesia. The research group has demonstrated that the use of an anaesthetic cream prior to the procedure is a safe way to effectively reduce circumcision pain.
"Despite evidence that infant boys experience intense pain with this procedure, many physicians have been reluctant to give analgesic drugs because of concern about possible side effects," explains the study leader, pharmacist Anna Taddio. She is completing her doctoral research at SickKids under the supervision of Dr. Gideon Koren, head of Clinical Pharmacology and Toxicology at SickKids and a professor of Paediatrics, Pharmacology, and Medicine at the University of Toronto. "We have now shown that there is a safe and easy way to significantly reduce the pain of this procedure," she adds.
The double-blind randomized study involved 68 full-term male neonates who were scheduled at the request of their parents to undergo circumcision at Women's College Hospital. A five percent lidocaine-prilocaine cream (Emla), a local anaesthetic, was applied to the penises of 38 infants prior to circumcision. The remaining 30 infants received a placebo cream.
During the circumcision, infants who received the anaesthetic cream spent less time crying, had smaller increases in heart rates, and had less facial activity (used to estimate pain) than infants in the placebo group. In addition, blood levels of lidocaine and prilocaine were low and none of the infants demonstrated systemic adverse reactions.
"Now that we have shown that giving an analgesic is necessary, safe and effective for the pain associated with circumcision, it is our hope that it will become common practice," says Dr. Koren.
At Women's College Hospital, where between 600 and 800 newborn circumcisions are performed each year, the study has already prompted a change in practice. The hospital has incorporated the use of Emla into their standard protocol for all newborn circumcisions, according to Dr. Andrew Shennan, WCH Neonatologist-in-Chief and Associate Professor of Paediatrics, U of T.
Besides Taddio, Koren and Shennan, other researchers involved in the study include WCH paediatrician Pratap Rastogi, as well as pain researchers Dr. Bonnie Stevens, U of T, and Dr. Kenneth Craig, University of British Columbia.
For more information, please contact:
Public Affairs
The Hospital for Sick Children
555 University Avenue
Suite 1742, Public Affairs, First floor Atrium
Toronto,
ON
M5G 1X8
Canada
Phone: 416-813-5058
Fax: 416-813-5328