Timing for maximum anaesthetic effect of topical cream during early infant circumcision (EIC) in Rakai, Uganda
Abstract Objectives The objective of this study is to determine the optimal timing for device‐based infant circumcision under topical anaesthesia. Subjects/patients We include infants aged 1–60 days who were enrolled in a field study of the no‐flip ShangRing device at four hospitals in the Rakai reg...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-07-01
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| Series: | BJUI Compass |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/bco2.223 |
| _version_ | 1797803501081853952 |
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| author | Stephen Kiboneka Aggrey Anok Regina Nakabuye Silas Odiya Julius Magembe Rose Nazziwa Charles Ddamulira Andrew Mulooki Ronald Moses Galiwango Stephen Watya Philip S. Li Richard K. Lee Ronald H. Gray Godfrey Kigozi Edward Nelson Kankaka |
| author_facet | Stephen Kiboneka Aggrey Anok Regina Nakabuye Silas Odiya Julius Magembe Rose Nazziwa Charles Ddamulira Andrew Mulooki Ronald Moses Galiwango Stephen Watya Philip S. Li Richard K. Lee Ronald H. Gray Godfrey Kigozi Edward Nelson Kankaka |
| author_sort | Stephen Kiboneka |
| collection | DOAJ |
| description | Abstract Objectives The objective of this study is to determine the optimal timing for device‐based infant circumcision under topical anaesthesia. Subjects/patients We include infants aged 1–60 days who were enrolled in a field study of the no‐flip ShangRing device at four hospitals in the Rakai region of south‐central Uganda, between 5 February 2020 and 27 October 2020. Methods Two hundred infants, aged 0–60 days, were enrolled, and EMLA cream was applied on the foreskin and entire penile shaft. The anaesthetic effect was assessed every 5 min by gentle application of artery forceps at the tip of the foreskin, starting at 10 min post‐application until 60 min, the recommended time to start circumcision. The response was measured using the Neonatal Infant Pain Scale (NIPS). We determined the onset and duration of anaesthesia (defined as <20% of infants with NIPS score >4) and maximum anaesthesia (defined as <20% of infants with NIPS score >2). Results Overall, NIPS scores decreased to a minimum and reversed before the recommended 60 min. Baseline response varied with age, with minimal response among infants aged 40 days. Overall, anaesthesia was achieved after at least 25 min and lasted 20–30 min. Maximum anaesthesia was achieved after at least 30 min (except among those aged >45 days where it was not achieved) and lasted up to 10 min. Conclusion The optimal timing for maximum topical anaesthesia occurred before the recommended 60 min of waiting time. A shorter waiting time and speed may be efficient for mass device‐based circumcision. |
| first_indexed | 2024-03-13T05:22:48Z |
| format | Article |
| id | doaj.art-f5ee0afe829d4ba2ae9153d61b53229b |
| institution | Directory Open Access Journal |
| issn | 2688-4526 |
| language | English |
| last_indexed | 2024-03-13T05:22:48Z |
| publishDate | 2023-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | BJUI Compass |
| spelling | doaj.art-f5ee0afe829d4ba2ae9153d61b53229b2023-06-15T11:33:01ZengWileyBJUI Compass2688-45262023-07-014442342910.1002/bco2.223Timing for maximum anaesthetic effect of topical cream during early infant circumcision (EIC) in Rakai, UgandaStephen Kiboneka0Aggrey Anok1Regina Nakabuye2Silas Odiya3Julius Magembe4Rose Nazziwa5Charles Ddamulira6Andrew Mulooki7Ronald Moses Galiwango8Stephen Watya9Philip S. Li10Richard K. Lee11Ronald H. Gray12Godfrey Kigozi13Edward Nelson Kankaka14Rakai Health Sciences Program Kalisizo UgandaRakai Health Sciences Program Kalisizo UgandaRakai Health Sciences Program Kalisizo UgandaRakai Health Sciences Program Kalisizo UgandaRakai Health Sciences Program Kalisizo UgandaRakai Health Sciences Program Kalisizo UgandaRakai Health Sciences Program Kalisizo UgandaRakai Health Sciences Program Kalisizo UgandaRakai Health Sciences Program Kalisizo UgandaWeill Cornell Medicine of Cornell University New York New York USAWeill Cornell Medicine of Cornell University New York New York USAWeill Cornell Medicine of Cornell University New York New York USAJohns Hopkins Bloomberg School of Public Health Baltimore Maryland USARakai Health Sciences Program Kalisizo UgandaRakai Health Sciences Program Kalisizo UgandaAbstract Objectives The objective of this study is to determine the optimal timing for device‐based infant circumcision under topical anaesthesia. Subjects/patients We include infants aged 1–60 days who were enrolled in a field study of the no‐flip ShangRing device at four hospitals in the Rakai region of south‐central Uganda, between 5 February 2020 and 27 October 2020. Methods Two hundred infants, aged 0–60 days, were enrolled, and EMLA cream was applied on the foreskin and entire penile shaft. The anaesthetic effect was assessed every 5 min by gentle application of artery forceps at the tip of the foreskin, starting at 10 min post‐application until 60 min, the recommended time to start circumcision. The response was measured using the Neonatal Infant Pain Scale (NIPS). We determined the onset and duration of anaesthesia (defined as <20% of infants with NIPS score >4) and maximum anaesthesia (defined as <20% of infants with NIPS score >2). Results Overall, NIPS scores decreased to a minimum and reversed before the recommended 60 min. Baseline response varied with age, with minimal response among infants aged 40 days. Overall, anaesthesia was achieved after at least 25 min and lasted 20–30 min. Maximum anaesthesia was achieved after at least 30 min (except among those aged >45 days where it was not achieved) and lasted up to 10 min. Conclusion The optimal timing for maximum topical anaesthesia occurred before the recommended 60 min of waiting time. A shorter waiting time and speed may be efficient for mass device‐based circumcision.https://doi.org/10.1002/bco2.223EICEIMCinfant circumcisionpain measurementtimingtopical anaesthesia |
| spellingShingle | Stephen Kiboneka Aggrey Anok Regina Nakabuye Silas Odiya Julius Magembe Rose Nazziwa Charles Ddamulira Andrew Mulooki Ronald Moses Galiwango Stephen Watya Philip S. Li Richard K. Lee Ronald H. Gray Godfrey Kigozi Edward Nelson Kankaka Timing for maximum anaesthetic effect of topical cream during early infant circumcision (EIC) in Rakai, Uganda BJUI Compass EIC EIMC infant circumcision pain measurement timing topical anaesthesia |
| title | Timing for maximum anaesthetic effect of topical cream during early infant circumcision (EIC) in Rakai, Uganda |
| title_full | Timing for maximum anaesthetic effect of topical cream during early infant circumcision (EIC) in Rakai, Uganda |
| title_fullStr | Timing for maximum anaesthetic effect of topical cream during early infant circumcision (EIC) in Rakai, Uganda |
| title_full_unstemmed | Timing for maximum anaesthetic effect of topical cream during early infant circumcision (EIC) in Rakai, Uganda |
| title_short | Timing for maximum anaesthetic effect of topical cream during early infant circumcision (EIC) in Rakai, Uganda |
| title_sort | timing for maximum anaesthetic effect of topical cream during early infant circumcision eic in rakai uganda |
| topic | EIC EIMC infant circumcision pain measurement timing topical anaesthesia |
| url | https://doi.org/10.1002/bco2.223 |
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