Journal of Rafsanjan University of Medical Sciences

  Comparing the Effect of 10% Lidocain Spray and Dorsal Penis Nerve Block on the Pain of Neonatal Circumcision

  M. Abedinzadeh MD [1] , M. Kazemi MSc [2] , G. Kholasezadeh MD [3] , V. Mashayekhi GP [4] , R. Vazirinejad PhD [5]

  Recived: 25/09/2005 Revised: 5/07/2006 Accepted: 15/07/2006

  Background and Objective: Neonates have complete insight into the pain. Pain not only causes physiologic and emotional alteration in neonates but also has long-term detrimental effects. Circumcision using dorsal penis nerve block is one of the most common surgical procedures in male neonates. Despite this method is effective, it has few complications. For instance, there is the risk of injecting lidocain in the vein and also there is the possibility of formation of hematoma on the injection site. However, lidocain spray does not cause these complications. The present study is conducted to compare the effect of these two methods on the level of pain after circumcision.

  Materials and Methods: This randomized clinical trail study was conducted on 54 neonates who were circumcised. Of these, 25 neonates were anaesthetized using lidocain spray 10%. The remaining (n=29) were received dorsal penis nerve block for the local anesthesia. The severity of pain was measured using Neonatal Infant Pain Scale (NIPS) in three different occasions when the circumcision procedure was being condacted (time 0), and 15 and 30 minutes after circumcision. Mann Whitney U test and t-test were used for comparing the severity of pain in the two groups.

  Results: In both groups severity of pain was decreasing over the time. The severity of pain among those who received dorsal penis nerve block was less than that of neonates in the other group in both occasions during circumcision (time 0) and 15 minutes after circumcision. However, there was no significant difference of pain severity between the two groups 30 minutes after circumcision.

  Conclusion: During circumaision and 15 minutes after the procedure, the effect of lidocain spray on the pain of circumcision was less than the effect of dorsal penis nerve block. However, 30 minutes after circumcision the effect of lidocain spray on the pain was comparable with the effect of dorsal penis nerve block method. It can be concluded that regarding the physiological and emotional responses after circumcision, in comparison with lidocain spray, dorsal penis nerve block can be a more effective method for relieving the pain caused by circumcision. However, more investigations are needed to study the side effects of this method.

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  Key words: Circumcision, Lidocain Spray, Dorsal Penis Nerve Block, Neonate

  [1] - Assistant tle w:st="on">Prof. Dept. of Urology, University of Medical Sciences, Rafsanjan

  (Corresponding Author) Tel: (021) 22588016, Fax: (021) 22588016, Email: abedin100@yahoo.com

  [2] - Academic Member, Dept. of Nursing, University of Medical Sciences, Rafsanjan

  [3] - Assistant tle w:st="on">Prof. Dept. of Psychiatry, University of Medical Sciences, Rafsanjan

  [4] -General Physician, University of Medical Sciences, Rafsanjan

  [5] - Assistant tle w:st="on">Prof. Dept. of Epidemiology, University of Medical Sciences, Rafsanjan

  Effective Factors on Perinatal Mortality in Rafsanjan Hospitals

  (2004-2006)

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  M. Hadavi [1] , S. Alidalaki [2] , M. Abedini nejad², F. Aminzadeh [3]

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  Received: 05/10/08 Sent for Revision: 04/01/09 Received Revised Manuscript: 21/05/09 Accepted: 03/06/09

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  Background and Objectives: Perinatal mortality is used as an indicator for evaluation of adequate perinatal and care services. Awareness of the major causes and effective factors on perinatal mortality play an important role in botl strengthening of obstetric services and in perinatal care planning (from pregnancy to birth and to neonatal care). The purpose of this study was to identify the effective factors on perinatal mortality in Rafsanjan city population.

  Materials and methods : This descriptive study was done on 321 cases of perinatal death over 2 years period. For each case, one baby who was living up to the 28th day after brith and it's age was the closest to the case, has chosen as the control group. Data was obtained from hospital records also by interview with the nurse, mother and obstetrician (or the person who delivered the baby). Data were analyzed by chi-square and t- tests.

  Results: ^{Perinatal mortality rate was 32.2 per 1000 (29.1 and 34.9 per 1000 for girls and boys, respectively). The most common causes of newborn mortality were prematurity (%53.8), respiratory distress syndrome (%20.5), septicemia (%6.4) and the common causes of stillbirth were premature rupture of amniotic membrane (%27.7), pregnancy induced hypertension (%8.9), placenta abruptio (%6.3) and congenital abnormality (%5.4). Statistical tests showed a significant relationship between the fetal weight, gestational age, history of stillbrith and birth rank with stillbirth. Twin births, maternal age, previous maternal disease, maternal weight gain during pregnancy and the number of pregnancy were among the risk factors that increased the newborn mortality rate.}

  Conclusion: According to the findings, several reasons such as maternal age, birth grade, the average of gestational age, history of stillbirth, birth weight and primigravida play important role in occurrence of perinatal mortality. High priorities should be given to the strengthening and improvement of the obstetric services and initiating preventive efforts for above mentioned causes of prinatal mortality.

  Key words: Mortality, Perinatal, Fetus, Newborn, Stillbirth

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  Funding: This research was funded by a Rafsanjan University of Medical Sciences.

  Conflict of interest: None declared.

  Ethical approval: The Ethics Committee of Rafsanjan University of Medical Sciences .

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  [1] -. Academic Member, Dept. of Anesthesiology, Nursing and Midwifery Faculty, University of Medical Sciences, Rafsanjan, Iran

  (Corresponding Author) Tel: (0391) 5228397, Fax: (0391) 5228497, E-mail: hadavimaryam@yahoo.com

  [2] - BSc, Nursing and Midwifery faculty, University of Medical Sciences, Rafsanjan, Iran

  [3] - Assistant Prof., Dept. of Gynecology , University of Medical Sciences, Rafsanjan, Iran