Pain Control During Infant Circumcision
Pain Control During Infant Circumcision
Circumcision is a painful surgical procedure frequently performed on newborn baby boys and often without available pain relief measures being used. The procedure, especially without pain relief, can cause short-term effects such as choking, gagging, and vomiting. Long term effects of circumcision without pain relief are not well understood, however, an increased incidence of intraventricular hemorrhage (IVH) and/or periventricular leukomalacia (PVL) has been associated with pain and stress in the neonate (Leef, 2006). Crying time, facial expression, and sweating palms can indicate infant pain, as can increased heart rate, breathing rate, and blood pressure. Although these behavioral and physiological changes are present at other times, the infant usually displays them during a circumcision that is not accompanied with effective pain relief. This paper reviews various pain relief methods and current residency training practices regarding the use of analgesia during the circumcision procedure.
Available treatments are used with the three most common circumcision surgical techniques: the Morgen clamp, the Gomco clamp, and the Plastibell method. Recent research suggests that the Morgen clamp is associated with a less painful procedure when compared with the other two (Leef, 2006; Yawman et al., 2006). Preferred by trainees, the Morgen clamp is also faster to use than the Plastibell (Yawman et al., 2006) and include local and topical pain relief methods, oral sucrose and oral acetaminophen. Dorsal penile nerve block (DPNB), which involves injecting anesthetic at the base of the penis, and subcutaneous ring block are the two most commonly used local anesthetics. Topically applied anesthetic creams include EMLA, a water-based cream that includes lidocaine and prilocaine. Although DPNB, ring block, and EMLA do not eliminate circumcision pain, all three are more effective than placebo or no treatment (Leef, 2006; Yawman
Circumcision is a painful surgical procedure frequently performed on newborn baby boys and often without available pain relief measures being used. The procedure, especially without pain relief, can cause short-term effects such as choking, gagging, and vomiting. Long term effects of circumcision without pain relief are not well understood, however, an increased incidence of intraventricular hemorrhage (IVH) and/or periventricular leukomalacia (PVL) has been associated with pain and stress in the neonate (Leef, 2006). Crying time, facial expression, and sweating palms can indicate infant pain, as can increased heart rate, breathing rate, and blood pressure. Although these behavioral and physiological changes are present at other times, the infant usually displays them during a circumcision that is not accompanied with effective pain relief. This paper reviews various pain relief methods and current residency training practices regarding the use of analgesia during the circumcision procedure.
Available treatments are used with the three most common circumcision surgical techniques: the Morgen clamp, the Gomco clamp, and the Plastibell method. Recent research suggests that the Morgen clamp is associated with a less painful procedure when compared with the other two (Leef, 2006; Yawman et al., 2006). Preferred by trainees, the Morgen clamp is also faster to use than the Plastibell (Yawman et al., 2006) and include local and topical pain relief methods, oral sucrose and oral acetaminophen. Dorsal penile nerve block (DPNB), which involves injecting anesthetic at the base of the penis, and subcutaneous ring block are the two most commonly used local anesthetics. Topically applied anesthetic creams include EMLA, a water-based cream that includes lidocaine and prilocaine. Although DPNB, ring block, and EMLA do not eliminate circumcision pain, all three are more effective than placebo or no treatment (Leef, 2006; Yawman