DPNBDorsal Penile Nerve Block
DPNBDipropylene Glycol Normal Butyl Ether
DPNBDescending Palatine Neurovascular Bundle
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DPNB is often associated with significant complications in case of intravascular injection.
A 56 day-old male patient was brought to the emergency department with a complaint of cyanosis two hours after administration of DPNB with prilocaine for two times at a dose of 1 mg/kg during circumscision and was internalized in the intensive care unit.
While an apparently simple and attractive option, five randomised controlled trials and one systematic review showed that topical EMLA cream was substantially inferior to DPNB and provides insufficient anaesthesia for neonatal circumcision (Table 1).
Categories for the choices of analgesia/anesthesia were Lidocaine Block- Ring or DPNB, Topical ELA-Max (which was currently used in this facility; EMLA cream was no longer supplied by the hospital pharmacy at the time of the study), as well as a commercially prepared 24% oral sucrose solution (Sweet-Ease, Children's Medical Ventures, Norwell, MA), or any combination thereof.
The use of DPNB significantly reduced objective measurements of pain and physiologic stress in infants undergoing circumcision.
The effectiveness and safety of DPNB make it the current standard against which future pain control techniques for newborn circumcision will be measured.
Many anaesthetists would argue that the DPNB is too simple to require ultrasound.
Conclusions: There is a trend toward better pain control with the DPNB as compared to EMLA.
To determine the types and rates of complications from DPNB used for neonatal circumcision, the authors conducted a retrospective review of hospital records of 1358 circumcised male infants delivered at an urban medical center during a 1-year period.
In 1989, the AAP issued an update, conceding that DPNB appeared effective in reducing newborn circumcision pain and stress and advising further study regarding local anesthesia (AAP, Task Force on Circumcision, 1989).
The local infiltration of lidocaine into the foreskin avoids some of the risks of the DPNB because it is administered to a very limited area away from large blood vessels (Myron & Maguire, 1991).