Pain of circumcision and pain control This page indexes material on the pain of neonatal male circumcision, its effects, and attempts to control circumcision pain. Introduction Before the late nineteenth century, medical doctors understood that infants feel pain. Talbert et al demonstrated a rise in serum cortisol during circumcision surgery in It is an accepted marker for pain.
The placebo represented current practice, with no anesthetic for neonatal circumcision. Those who do not are called "subjects" or "victims". Surgical procedures defined the following 4 A research on infant circumcision of the circumcision: Methemoglobin level was assessed 6 hours after surgery.
There was no untreated control group] exhibited homogeneous responses that consisted of sustained elevation of heart rate and high pitched cry throughout the circumcision and following. Two newborns in the placebo group became ill following circumcision choking and apnea [i.
The 3 treatment groups all had significantly less crying and lower heart rates during and following circumcision compared with the treated group. The ring block was equally effective through all stages of the circumcision, whereas the dorsal penile nerve block and EMLA were not effective during foreskin separation and incision.
Methemoglobin levels were highest in the EMLA group, although no newborn required treatment. It is our recommendation that an anesthetic should be administered to newborns prior to undergoing circumcision. It seems the option of leaving any babies uncircumcised was deliberately avoided.
RESULTS Part way through the trial, physicians and members of the research team remarked that there were obvious differences in behavior of newborns in either infiltration group compared with those in both topical groups.
This led us to reexamine our estimation of effect size as well as the ethical matters related to sample size. There was nothing remarkable about this newborn's history prior to the circumcision. His 1- and 5-minute Apgar scores were 9 and He was last fed 3 hours before circumcision.
During and following circumcision, the newborn reacted much the same as others who received a placebo continuously elevated heart rate and high-pitched cry. No physiological data were recorded during the episode, since the computer had lost contact with the monitor immediately prior to its onset.
The newborn recovered following the episode. Another newborn in the placebo group had a choking episode with apnea after surgery.
This began about 3. This analysis is on another page. In a baby died after his circumcision, and in response to a complaint the doctor gave reasons he still does not use anaesthesia. Williamson and Evans found that, contrary to a common claim, circumcision hurts much more than a heelstick, and local anaesthetic is ineffective.
Clinical Pediatrics August vol. Williamson, Nolan Donovan Evans [Paul Williamson was a co-author of the much-cited Iowa study that claimed to show women prefer circumcised men. One of its subjects has since written how it was skewed.
The adrenal cortisol response to surgery was not significantly reduced by the administration of lidocaine. Blood sampling and anesthetic injection of venipuncture alone did not evoke the adrenal response in uncircumcised control infants.
Cortical input or secondary epinephrine elevation may be producing the cortisol elevation in infants despite regional blockage of the afferent nerve pathways. The Lancet, Early Online Publication, 1 September Oral sucrose as an analgesic drug for procedural pain in newborn infants: Oral sucrose is frequently given to relieve procedural pain in neonates on the basis of its effect on behavioural and physiological pain scores.
Randomisation was by a computer-generated randomisation code, and researchers, clinicians, participants, and parents were masked to the identity of the solutions. The primary outcome was pain-specific brain activity evoked by one time-locked heel lance, recorded with electroencephalography and identified by principal component analysis.
Secondary measures were baseline behavioural and physiological measures, observational pain scores PIPPand spinal nociceptive reflex withdrawal activity.
Data were analysed per protocol. Findings 29 infants were assigned to receive sucrose and 30 to sterilised water; 20 and 24 infants, respectively, were included in the analysis of the primary outcome measure. Nociceptive [indicative of pain] brain activity after the noxious heel lance did not differ significantly between infants who received sucrose and those who received sterile water sucrose: No significant difference was recorded between the sucrose and sterile water groups in the magnitude or latency of the spinal nociceptive reflex withdrawal recorded from the biceps femoris of the stimulated leg.
The ability of sucrose to reduce clinical observational scores after noxious events in newborn infants should not be interpreted as pain relief.
This study was catalyzed by our hospital's obstetric service choice not to carry out circumcisions because of their belief that it was medically unjustified.New scientific evidence shows the health benefits of newborn male circumcision outweigh the risks of the procedure, but the benefits are not great enough to recommend routine circumcision for all newborn boys, according to an updated policy statement published by the American Academy of Pediatrics (AAP).
Because the medical risk: benefit ratio of routine newborn male circumcision is closely balanced when current research is reviewed (Table 1), it is challenging to make definitive recommendations for the entire male newborn population in Canada.
For some boys, the likelihood of benefit is higher and circumcision could be considered for disease . The wellness lifestyle includes making informed health care choices for you and your family.
This page offers numerous in-depth research for you on pregnancy, birth, and childhood health concerns. The Committee on Fetus and Newborn of the American Academy of Pediatrics stated in that there are no valid medical indications for circumcision in the neonatal period.
The present committee has undertaken a review of data to support arguments "pro" and "con" circumcision of the newborn, and finds no basis for changing this statement. After reviewing existing medical research, the American Academy of Pediatrics announced in that circumcision has no medical benefit and shouldn't be recommended for all baby boys.
And by , only 61% of American parents were circumcising their sons. Plain language answers to your infant circumcision questions. Circumcision facts, video, and foreskin care guide.