The Incidence of Methemoglobinemia Due to Prilocaine Use in Circumcision

Objective: Local anesthesia with prilocaine is widely used in circumcision procedures. However, the incidence of methemoglobinemia due to prilocaine use during these procedures remains unknown. Therefore, this retrospective study was planned to determine the possibility of development of prilocaine-associated methemoglobinemia during circumcision. Materials and Methods: Medical records of 2.431 patients who were circumcised between 2008 and 2015 in University of Health Sciences, İzmir Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Turkiye, were evaluated. Prior to all circumcision procedures, 1.5 mg/kg of local anesthetic was subcutaneously administered to the penis root at 4-5 points from a 20 mL vial containing 400 mg (20 mg/mL) of prilocaine (2 ). Results: Of the 2.431 patients included in the study, two (0.008 ) developed methemoglobinemia requiring treatment. According to the medical records, five patients (0.021 ) developed mild bruising on the hands, feet and sides of the lips. Conclusion: Prilocaine is more frequently encountered as a cause of acquired methemoglobinemia in newborns and children compared to adults. Determining the causative factor for methemoglobinemia and undertaking early and effective application of methylene blue or ascorbic acid can be life-saving.

Prilokain ile Yapılan Sünnetlerde Methemoglobinemi İnsidansı

Amaç: Sirkümsizyon işleminde prilokain ile lokal anestezi uygulaması yaygın olarak kullanılmaktadır. Sirkümsizyon esnasında prilokain kullanımına bağlı methemoglobinemi insidansı bilinmemektedir. Bu retrospektif çalışma sirkümsizyon sırasında kullanılan prilokaine bağlı methemoglobinemi gelişme olasılığını ortaya koymak amacıyla planlanmıştır. Gereç ve Yöntem: Sağlık Bilimleri Üniversitesi, İzmir Dr. Suat Seren Göğüs Hastalıkları ve Cerrahisi Eğitim ve Araştırma Hastanesi, Üroloji Kliniği’ne 2008-2015 arasında gelen 2431 hastanın dosyaları incelendi. Tüm sirkümsizyon işlemlerinden önce, 20 mL’lik her flakonda 400 mg (20 mg/mL) prilokain ( 2) içeren lokal anestezik 1,5 mg/kg olarak penis köküne 4-5 noktadan deri altına uygulandı. Bulgular: Sağlık Bilimleri Üniversitesi, İzmir Dr. Suat Seren Göğüs Hastalıkları ve Cerrahisi Eğitim ve Araştırma Hastanesi, Üroloji Kliniği’ne 2008-2015 arasında gelen 2431 hastanın dosyaları incelendi. Çalışmaya dahil edilen 2431 hastadan iki hastada ( 0,008) tedavi gerektiren methemoglobinemi gelişti. Beş hastada ( 0,021) ise el, ayak ve dudak kenarlarında hafif düzeyde morarma olduğu anamnezde tespit edildi. Sonuç: Yenidoğan ve çocuklarda edinsel methemoglobinemi olgularının erişkine oranla görece sık methemoglobinemi sebeplerinden biri olarak karşımıza çıkmıştır. Methemoglobinemiye neden olan faktörün saptanması, erken ve etkin şekilde askorbik asit veya metilen mavisi uygulanması yaşam kurtarıcı olmaktadır.

Kaynakça

1. Lui KC, Chow YF. Safe use of local anaesthetics: prevention and management of systemic toxicity. Hong Kong Med J 2010;16:470-475. 2. Trapp L, Will J. Acquired methemoglobinemia revisited. Dent Clin North Am 2010;54:665-675.

3. Benini D, Vino L, Fanos V. Acquired methemoglobinemia: A case report. Pediatr Med Chir 1998;20:411-413.

4. Coleman MD, Coleman NA. Drug induced methaemoglobinemia. Drug Safety 1996;14:394-405.

5. Kreutz RW, Kinni ME. Life-threatening toxic methemoglobinemia induced by prilocaine. Oral Surg Oral Med Oral Pathol 1983;56:480-482.

6. Liao YP, Hung DZ, Yang DY. Hemolytic anemia after methylene blue therapy for aniline-induced methemoglobinemia. Vet Hum Toxicol 2002;44:19-21.

7. Kara A, Yigit S, Aygün C, Oran O. Toxic methemoglobinemia after injection of prilocaine in a newborn. Turk J Pediatr 1998;40:589-592.

8. Nishimura K. Methemoglobinemia due to local anesthetics. Osaka City Med J 1971;17:25-42.

9. Taddio A, Stevens B, Craig K, Rastogi P, Ben-David S, Shennan A, Mulligan P, Koren G. Efficacy and safety of lidocaine-prilocaine cream for pain during circumcision. N Engl J Med 1997;336:1197-1201.

10. Moore PA, Hersh EV. Local anesthesia toxicity review revisited. Pediatr Dentistry 2000;22:7-8.

11. Nilsson A, Engberg G, Henneberg S, Danielson K, De Verdier CH. Inverse relationship between age - dependent erythrocyte activity of methaemoglobin reductase and prilocaine-induced methaemoglobinaemia during infancy. Br J Anaesthesia 1990;64:72-76.

12. Kumar AR, Dunn N, Naqvi M. Methemoglobinemia associated with a prilocainelidocaine cream. Clin Pediatr 1997;36:239-240.

13. Gunter JB. Benefit and risks of local anesthetics in infants and children. Pediatr Drugs 2002;4:649-672.

14. Frey B, Kehrer B. Toxic methaemoglobin concentrations in premature infants after application of a prilocaine containing cream and peridural prilocaine. Eur J Pediatr 1999;158:785-788.

15. Akbayram S, Akgün C, Doğan M, Gündogdu M, Caksen H, Oner AF. Acquired methemoglobinemia due to application of prilocaine during circumcision. J Emerg Med 2012;43:120-1211.

16. Mansouri A. Methemoglobinemia. Am J Med Sci 1985;289:200-209.

17. Guay J. Methemoglobinemia related to local anesthetics: A summary of 242 episodes. Anesth Analg 2009;108:837-845.

18. Soeding P, Deppe M, Gehring H. Pulse-oximetric measurement of prilocaine-induced methemoglobinemia in regional anesthesia. Anesth Analg 2010;111:1065-1068.

Kaynak Göster

  • ISSN: 2148-9580
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2014

2.4b 1.6b

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