Anesthesia for neonatal circumcision: local anesthesia is better than dorsal penile nerve block

Article Abstract:

Circumcision is a surgical procedure performed on newborn male infants to remove the foreskin surrounding the penis. There is increasing evidence that newborns experience pain during circumcision. Studies have shown that infants who receive anesthesia are less irritable and more easily quieted than infants who receive no anesthesia. Pain can be assessed not only by behavioral changes but by changes in heart rate, oxygen uptake in the skin, levels of cortisol (a hormone produced by the adrenal gland) and blood pressure. Dorsal penile nerve block is a type of anesthesia in which the anesthetic agent lidocaine is injected at the base of the penis. To see if dorsal penile block is effective in reducing the pain of circumcision, infants being prepared for circumcision were given either dorsal penile block (10 infants); local anesthesia, where the agent is injected directly into the foreskin (10 infants); or no anesthesia (10 infants). The infants receiving anesthesia had on average a smaller increase in heart rate, a smaller decrease in oxygen saturation, and cried less than the infants not receiving anesthesia. All the infants not receiving any anesthesia cried throughout the entire procedure. Fewer infants in the group receiving local anesthesia cried during every step of the procedure than in the other two groups. Although both types of anesthesia were effective in anesthetizing the bottom portion of the penis, the infants receiving local anesthesia experienced less pain when the procedure involved the top portion of the penis. The cortisol levels a half an hour following the procedure were lower in the local anesthesia group than in the other two groups. It is concluded that although both types of anesthesia lessened the pain of circumcision, local anesthesia was more effective in preventing crying, reducing rapid heart beats and releasing cortisol. Local anesthesia is well tolerated and easily performed. None of the infants experienced complications. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Surgery, Penis

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Epidural anesthesia, episiotomy, and obstetric laceration

Article Abstract:

In epidural anesthesia, the anesthetic is administered into the epidural space located outside of the dura mater, the outer membrane covering the spinal cord and brain. Epidural anesthesia is beneficial during childbirth in relieving labor pain, and relaxing the muscles surrounding the birth canal, thereby helping in delivery. Episiotomy is a surgical incision into the perineum, the tissue between the vagina and anus, intended to increase the size of the opening during delivery and thus avoid spontaneous laceration. The benefits of an episiotomy in reducing disability associated with childbirth, protecting against damage to the genital organs, or reducing tears in the perineum are not clear. The relation between epidural anesthesia, episiotomy, laceration of the perineum, use of forceps, and parity (number of successful pregnancies) was assessed in 9,493 deliveries. Episiotomy, but not epidural anesthesia, was associated with an increase in injury to the birth canal during childbirth. In addition, trauma to the birth canal associated with episiotomy was more likely to be major, as compared with injury in the absence of episiotomy. However, episiotomy did decrease the rate of laceration of the perineum. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Complications and side effects, Perineum, Peridural anesthesia, Epidural anesthesia, Episiotomy

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Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision: a randomized controlled trial

Article Abstract:

Ring block appears to be the most effective form of anesthesia when circumcising newborn male infants. This form of anesthesia is administered by injecting the anesthetic in a ring around the penis. It was compared to anesthetics injected into the dorsal penile nerve and anesthetics applied topically to the penis as well as to a placebo in 52 newborn male infants. The rates of crying were lower with all the anesthetics compared to the placebo, but the ring block was the only one that was effective throughout the entire procedure.

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