Objectives: Tongue-tie release (frenotomy) is a relatively common procedure in young infants. This study aimed at examining the effect of two topical anesthetics on distress response during frenotomy.
Methods: We conducted a randomized controlled trial involving 42 infants aged 0-3 months who were referred to the Pediatric Craniofacial Clinic for frenotomy due to breastfeeding difficulties. Patients received a topical anesthetic 2% tetracaine or 20% benzocaine prior to frenotomy. Frenotomies were videotaped using a video camera placed on the surgeon`s forehead. Distress response was evaluated using the Neonatal Facial Coding System (NFCS) score (0-40), cry duration, and parent`s Visual Analog Scale (VAS) score.
Results: The two groups were comparable with regard to weight, age, gender, previous painful experience, and last feeding time. Median NFCS scores prior to frenotomy in the tetracaine and in the benzocaine groups were 4.5 (interquartile range, (IQR): 0.75-10.2) and 3.5 (IQR: 0-9.5) respectively (p=0.89, 95% CI -3 to 4). During frenotomy median NFCS score increased to 28 (IQR: 24.5-30.25) in the tetracaine group (p<0.0001, median difference -22, 95% CI -24.5 to -19), and to 28 (IQR: 26-30) in the benzocaine group (p<0.0001, median difference -23, 95% CI -27 to -17). Mean cry durations in the tetracaine and the benzocaine groups were 69.4 seconds and 63.9 seconds respectively (p=0.32, 95% CI -47 to 15). Mean VAS scores in the tetracaine and in the benzocaine groups were 57.2 and 58.2 respectively (p=0.89, 95% CI -15.2 to 13.4).
Discussion: Frenotomy induced significant distress response despite the use of topical anesthetics.
