SAFETY AND EFFICACY OF A TOPICAL ANESTHETIC FOR NEONATAL CIRCUMCISION

Objective. Circumcision is a common neonatal surgical procedure routin ely performed without the use of anesthesia. The purpose of this study was to evaluate the safety and efficacy of topical lidocaine cream as an anesthetic for circumcision. Methods. Thirty newborns were studied in a randomized, double-blind, placebo-controlled study; 15 received a topical 30% lidocaine cream and 15 received the cream base alone. Vi tal signs were recorded, and preoperative and postoperative serum beta -endorphin and lidocaine concentrations were measured. A videotape of the newborn was used to score behavioral changes. Results. Comparision s of the vital signs precircumcision and postcircumcision showed no di fferences between the placebo and treatment groups, with the exception of mean systolic blood pressure, which significantly increased in the placebo-treated newborns (P < .05). Serum beta-endorphin concentratio ns increased postoperatively in 11 of 15 subjects receiving placebo, b ut decreased or remained unchanged in 10 of 15 subjects receiving lido caine (P = .03, Fisher's exact test). When stress-related behaviors in the precircumcision and post-circumcision periods were compared, the mean increase in their occurrence was greater in the placebo than in t he treatment group. There was no significant absorption of lidocaine a s measured in the serum. Conclusion. Topical application of a 30% lido caine cream as used in this study may be a safe and efficacious anesth etic for circumcision.