ABSTRACT
Dorsal penile nerve blocking (DPNB) has been used with success in decreasing neonatal
stress during circumcision. This study was designed to confirm the effectiveness of
lidocaine in DPNB and to demonstrate that chloroprocaine, a shorter acting anesthetic,
is as effective in blocking circumcision stress as lidocaine, but, because of its
shorter plasma elimination half-life and time of onset of action, is safer. Five groups
of 15 neonates were matched for weight, age, and Apgar scores and randomly assigned
to a control group, one lidocaine group and three chloroprocaine groups with 2-, 3-
and 5-minute postinjection waiting periods. Each neonate was subjected to six events
during circumcision for which heart rate, tissue oxygenation, and cry duration were
recorded. We found that, as in previous investigations, DPNB with lidocaine was effective
in reducing neonatal stress, as was evident from decreased excursion from baseline
heart rate, tissue oxygenation, and cry duration when compared with the control group
(nonblocked). Furthermore, chloroprocaine DPNB approximates the effectiveness of lidocaine,
as was evident from decreased change from baseline cry duration, tissue oxygenation,
and heart rate during the most stressful events, particularly in the 3-minute wait
chloroprocaine group. This more rapid onset of regional anesthesia decreases DPNB
circumcision time and benefits patients, parents, and physicians.
