A Randomized Comparative Study of Pain Management: Oral Acetaminophen Versus Topical Lidocaine With/Without Epinephrine in Neonatal Circumcision

The study assessed whether effective pain management of the neonate could be achieved through topical approaches rather than acetaminophen in circumcision. Epinephrine and/or Lidocaine solutions with clinically proven safety were preferred for topical use. 

This study was conducted by separating 105 neonates into three groups, each of which consisted of 35 patients. The group I was followed up and assessed by performing pain management using only acetaminophen; in Group II topical liquid local anesthetic medication without Epinephrine. In Group III topical liquid local anesthetic medication with Epinephrine was used in pain management, including acetaminophen, to reduce oral medication if necessary. The pain was monitored using the Neonatal Infant Pain Scale.

In all three groups, it has been shown statistically that topical medication effectively relieves pain and reduces the need for oral medication. In the comparison of Group II and Group III, it was found that the presence of pain was lesser in the use of lidocaine containing epinephrine and less oral medication was required (p<0.001 & p<0.001). The frequency of topical application in Group II was statistically significantly lower compared to Group I (p<0.001). Topical administration containing Epinephrine was more effective compared to the group using only oral acetaminophen or liquid lidocaine without Epinephrine (p<0.001 & p<0.001). 

Painless procedures should be preferred in surgical procedures of neonates. If painful procedures need to be performed, effective pain management plans should be set up beforehand. Few oral medications can be used in the management of pain in neonates. In surgical procedures such as circumcision, intensive medication use is required, topical pain-relieving medications can be used to avoid or reduce the need for drugs that may have adverse effects.