The Incidence of Methemoglobinemia Due to Prilocaine Use in Circumcision

Abstract

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.

Keywords

• Prilocaine
• Circumcision
• Methemoglobinemia
• Local anesthesia
• Complications