TY - JOUR
T1 - Efficacy and safety of lidocaine-prilocaine cream for pain during circumcision
AU - Taddio, Anna
AU - Stevens, Bonnie
AU - Craig, Kenneth
AU - Rastogi, Pratap
AU - Ben-David, Shlomit
AU - Shennan, Andrew
AU - Mulligan, Peggy
AU - Koren, Gideon
N1 - Funding Information:
rent research, funding, and academic status and problems they have encountered. Additionally, each respondent was encouraged to make specific suggestions on how to improve these programs. RESULTS: Of the 54 surveys sent, all were returned (100%). Of these respondents, 30 had American Association of Obstetricians and Gynecologists Foundation fellowships and 24 were in the Reproductive Scientist Development Program, representing 29 different academic programs. Forty-nine (91%) had academic appointments and 6 were either division directors or departmental chairs. Of 39 graduates, 23 (59%) received funding from the National Institutes of Health. Thirty-one past fellows continued basic research and 23 (73%) work in their own or departmental laboratories. Of all respondents, 78% felt that they had good to excellent chances of obtaining funding, and 94% felt that participating in the research training fellowships was critically important for their academic careers. CONCLUSIONS: Research training fellowships sponsored by the American Association of Obstetricians and Gynecologists Foundation and the Reproductive Scientist Development Program have been extremely successful at keeping talented young obstetricians and gynecologists in academic medicine. Most fellows continue basic science research and have obtained extramural funding. In spite of the current stresses in academic medicine regarding financial restructuring and research funding, these fellowships continue to provide outstanding opportunities for motivated young obstetricians and gynecologists to achieve academic success.
PY - 1997/4/24
Y1 - 1997/4/24
N2 - Background: Neonatal circumcision is a painful surgical procedure often performed without analgesia. We assessed the efficacy and safety of 5 percent lidocaine-prilocaine cream (Emla) in neonates undergoing circumcision. Methods: We carried out a double-blind, randomized, controlled trial in 68 full-term male neonates: 38 were assigned to receive lidocaine-prilocaine cream, and 30 to receive placebo. One gram of lidocaine-prilocaine or placebo cream was applied to the penis under an occlusive dressing for 60 to 80 minutes before circumcision. Behavioral (facial activity and time spent crying) and physiologic (heart rate and blood pressure) responses were recorded during the procedure. Blood samples were obtained at various times after drug application for measurements of methemoglobin and plasma lidocaine, prilocaine, and o-toluidine (a metabolite of prilocaine). Results: A total of 68 and 59 neonates were included in the safety and efficacy analyses, respectively. Demographic characteristics such as gestational age and birth weight did not differ between the lidocaine-prilocaine and placebo groups. During circumcision, the neonates in the lidocaine-prilocaine group had less facial activity (P=0.01), spent less time crying (P<0.001), and had smaller increases in heart rate (P=0.007) than the neonates in the placebo group. Facial-activity scores were 12 to 49 percent lower during various steps of the procedure in the lidocaine-prilocaine group. As compared with neonates in the placebo group, infants in the lidocaine-prilocaine group cried less than half as much and had heart-rate increases of 10 beats per minute less. Blood methemoglobin concentrations (expressed as a percentage of the hemoglobin concentration) were similar (1.3 percent) in both groups. Lidocaine and prilocaine were detected in plasma in 23 (61 percent) and 21 (55 percent) of the infants treated with lidocaine-prilocaine cream, respectively. Conclusions: Lidocaine-prilocaine cream is efficacious and safe for the prevention of pain from circumcision in neonates.
AB - Background: Neonatal circumcision is a painful surgical procedure often performed without analgesia. We assessed the efficacy and safety of 5 percent lidocaine-prilocaine cream (Emla) in neonates undergoing circumcision. Methods: We carried out a double-blind, randomized, controlled trial in 68 full-term male neonates: 38 were assigned to receive lidocaine-prilocaine cream, and 30 to receive placebo. One gram of lidocaine-prilocaine or placebo cream was applied to the penis under an occlusive dressing for 60 to 80 minutes before circumcision. Behavioral (facial activity and time spent crying) and physiologic (heart rate and blood pressure) responses were recorded during the procedure. Blood samples were obtained at various times after drug application for measurements of methemoglobin and plasma lidocaine, prilocaine, and o-toluidine (a metabolite of prilocaine). Results: A total of 68 and 59 neonates were included in the safety and efficacy analyses, respectively. Demographic characteristics such as gestational age and birth weight did not differ between the lidocaine-prilocaine and placebo groups. During circumcision, the neonates in the lidocaine-prilocaine group had less facial activity (P=0.01), spent less time crying (P<0.001), and had smaller increases in heart rate (P=0.007) than the neonates in the placebo group. Facial-activity scores were 12 to 49 percent lower during various steps of the procedure in the lidocaine-prilocaine group. As compared with neonates in the placebo group, infants in the lidocaine-prilocaine group cried less than half as much and had heart-rate increases of 10 beats per minute less. Blood methemoglobin concentrations (expressed as a percentage of the hemoglobin concentration) were similar (1.3 percent) in both groups. Lidocaine and prilocaine were detected in plasma in 23 (61 percent) and 21 (55 percent) of the infants treated with lidocaine-prilocaine cream, respectively. Conclusions: Lidocaine-prilocaine cream is efficacious and safe for the prevention of pain from circumcision in neonates.
UR - http://www.scopus.com/inward/record.url?scp=0030995915&partnerID=8YFLogxK
U2 - 10.1056/NEJM199704243361701
DO - 10.1056/NEJM199704243361701
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C2 - 9110906
AN - SCOPUS:0030995915
SN - 0028-4793
VL - 336
SP - 1197
EP - 1201
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 17
ER -