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Anaesthesia for Circumcision

A Review of the Literature
  • Robert S. Van Howe

Abstract

For most of this century, physicians have been performing procedures and surgeries on newborns without anaesthesia under the mistaken notion that newborns were not neurologically complex enough to experience pain. Although this myth has been dispelled, the most commonly performed surgery in the newborn period, circumcision, continues to be performed, in the majority of cases, without any attempt at pain relief. In 1994, only 4% of obstetricians under 34 years of age used an anaesthetic for neonatal circumcision. Overall, the rate of anaesthetic use was 14% among obstetricians, with 20% of the female obstetricians using anaesthetic. A subsequent survey, distributed in 1996, found that anaesthetic use had increased to 25% among obstetricians. As routine circumcision comes under attack and its frequency declines, proponents of mass circumcision have begun advocating the use of anaesthesia in an attempt to reverse the professional and popular shift against routine neonatal circumcision. Like most of the information that is used to perpetuate neonatal circumcision, the literature on anaesthesia contains a mixture of truth and hyperbole. This article will review the medical research regarding topical and local anaesthesia for neonatal circumcision and its effectiveness.

Keywords

Cortisol Level Plasma Cortisol Level Vagal Tone Lidocaine Group Quiet Sleep 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Anand KJS, Hickey PR. Pain and its effects in the human neonate and fetus. N Engl J Med 1987;317:1321–9.PubMedGoogle Scholar
  2. 2.
    Gamy T. Circumcision: a survey of fees and practices. OBG Management (October 1994):34–6.Google Scholar
  3. 3.
    Stang HJ, Snellman LW. Circumcision practice patterns in the United States. Pediatrics 1998;101(6): URL. http://www.pediatricorg/cgi/content/full/l0l/6/e5.
  4. 4.
    Cold CJ. Neonatal circumcision. Lancet 1997;349:1257–8.PubMedGoogle Scholar
  5. 5.
    Porter FL, Porges SW, Marshall RE. Newborn pain cries and vagal tone: parallel changes in response to circumcision. Child Dev 1988;59:495–505.PubMedGoogle Scholar
  6. 6.
    Gunnar MR, Porter FL, Wolf CM, Rigatuso J, Larson MC. Neonatal stress reactivity: predictions to later emotional temperment. Child Dev 1995;66:1–13.PubMedGoogle Scholar
  7. 7.
    Gunnar MR, Porter FL, Wolf CM, Rigatuso J, Larson MC. Neonatal stress reactivity: predictions to later emotional temperment. Child Dev 1995;66:1–13.PubMedGoogle Scholar
  8. 8.
    Lander J, Brady-Fryer B, Metcalfe JB, Nazarali S, Muttitt S. Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision. JAMA 1997;278:2157–62.PubMedGoogle Scholar
  9. 9.
    Porter FL, Porges SW, Marshall RE. Newborn pain cries and vagal tone: parallel changes in response to circumcision. Child Dev 1988;59:495–505.PubMedGoogle Scholar
  10. 10.
    Porter FL, Miller RH, Marshall RE. Neonatal pain cries: effect of circumcision on acoustic features and perceived urgency. Child Dev 1986;57:790–802.PubMedGoogle Scholar
  11. 11.
    Porter FL, Porges SW, Marshall RE. Newborn pain cries and vagal tone: parallel changes in response to circumcision. Child Dev 1988;59:495–505.PubMedGoogle Scholar
  12. 12.
    Gunnar MR, Fisch RO, Malone S. The effects of a pacifying stimulus on behavioral and adrenocortical responses to circumcision in the newborn. J Am Acad Child Psychiatry 1984;23:34–8.PubMedGoogle Scholar
  13. 13.
    Gunnar MR, Fisch RO, Korsvik S, Donhowe JM. The effects of circumcision on serum cortisol and behavior. Psychoneuroendocrinology 1981;6:269–75.PubMedGoogle Scholar
  14. 14.
    Gunnar MR, Fisch RO, Korsvik S, Donhowe JM. The effects of circumcision on serum cortisol and behavior. Psychoneuroendocrinology 1981;6:269–75.PubMedGoogle Scholar
  15. 15.
    Goldman R. Circumcision The Hidden Trauma: How an American Cultural Practice Affects Infants and Ultimately Us All. Boston: Vanguard Publications. 1997.Google Scholar
  16. 16.
    Rawlings DJ, Miller PA, Engel RR. The effect of circumcision on transcutaneous P02 in term infants. Am J Dis Child 1980;134:676–8.PubMedGoogle Scholar
  17. 17.
    Benini F, Johnston CC, Faucher D, Aranda W. Topical anesthesia during circumcision in newborn infants. JAMA 1993;270:850–3.PubMedGoogle Scholar
  18. 18.
    Herschel M, Khoshnood B, Ellman C, Maydew N, Mittendorf R. Neonatal circumcision: randomized trial of sucrose pacifier for pain control. Arch Pediatr Adolesc Med 1998;152:279–84.PubMedGoogle Scholar
  19. 19.
    Mohan CG, Risucci DA, Casimir M, Gulrajani-LaCorte M. Comparison of analgesics in ameliorating the pain of circumcision. J Perinatol 1998;18:13–9.PubMedGoogle Scholar
  20. 20.
    Williamson ML. Circumcision anesthesia: a study of nursing implications for dorsal penile nerve block. Pediatr Nurs 1997;23:59–43.PubMedGoogle Scholar
  21. 21.
    Williamson PS, Williamson ML. Physiologic stress reduction by a local anesthetic during newborn circumcision. Pediatrics 1983;71:36–40.PubMedGoogle Scholar
  22. 22.
    Arnett RM, Jones JS, Horger EO 3d Effectiveness of 1 % lidocaine dorsal penile nerve block in infant circumcision. Am J Obstet Gynecol 1990;163:1074–80.PubMedGoogle Scholar
  23. 23.
    Masciello AL. Anesthesia for neonatal circumcision: local anesthesia is better than dorsal penile nerve block. Obstet Gynecol 1990;75:834–8.PubMedGoogle Scholar
  24. 24.
    Gunnar MR, Porter FL, Wolf CM, Rigatuso J, Larson MC. Neonatal stress reactivity: predictions to later emotional temperment. Child Dev 1995;66:1–13.PubMedGoogle Scholar
  25. 25.
    Gunnar MR, Fisch RO, Malone S. The effects of a pacifying stimulus on behavioral and adrenocortical responses to circumcision in the newborn. J Am Acad Child Psychiatry 1984;23:34–8.PubMedGoogle Scholar
  26. 26.
    Gunnar MR, Fisch RO, Korsvik S, Donhowe JM. The effects of circumcision on serum cortisol and behavior. Psychoneuroendocrinology 1981;6:269–75.PubMedGoogle Scholar
  27. 27.
    Gunnar MR, Malone S, Vance G, Fisch RO. Coping with aversive stimulation in the neonatal period: quiet sleep and plasma cortisol levels during recovery from circumcision. Child Dev 1985;56:824–34.PubMedGoogle Scholar
  28. 28.
    Talbert LM, Kraybill EN, Potter HD. Adrena1 cortical response to circumcision in the neonate. Obstet Gynecol 1976;48:208–10.PubMedGoogle Scholar
  29. 29.
    Lander J, Brady-Fryer B, Metcalfe JB, Nazarali S, Muttitt S. Comparison of ring block. dorsal penile nerve block, and topical anesthesia for neonatal circumcision. JAMA 1997;278:2157–62.PubMedGoogle Scholar
  30. 30.
    Williamson ML. Circumcision anesthesia: a study of nursing implications for dorsal penile nerve block. Pediatr Nurs 1997;23:59–43.PubMedGoogle Scholar
  31. 31.
    Porter FL, Porges SW, Marshall RE. Newborn pain cries and vagal tone: parallel changes in response to circumcision. Child Dev 1988;59:495–505.PubMedGoogle Scholar
  32. 32.
    Porter FL, Porges SW, Marshall RE. Newborn pain cries and vagal tone: parallel changes in response to circumcision. Child Dev 1988;59:495–505.PubMedGoogle Scholar
  33. 33.
    Gunnar MR, Porter FL, Wolf CM, Rigatuso J, Larson MC. Neonatal stress reactivity: predictions to later emotional temperment. Child Dev 1995;66:1–13.PubMedGoogle Scholar
  34. 34.
    Gunnar MR, Fisch RO, Malone S. The effects of a pacifying stimulus on behavioral and adrenocortical responses to circumcision in the newborn. J Am Acad Child Psychiatry 1984;23:34–8.PubMedGoogle Scholar
  35. 35.
    Gunnar MR, Fisch RO, Korsvik S, Donhowe JM. The effects of circumcision on serum cortisol and behavior. Psychoneuroendocrinology 1981;6:269–75.PubMedGoogle Scholar
  36. 36.
    Talbert LM, Kraybill EN, Potter HD. Adrenal cortical response to circumcision in the neonate. Obstet Gynecol 1976;48:208–10.PubMedGoogle Scholar
  37. 37.
    Gunnar MR, Connors J, Isensee J, Wall L. Adrenocortical activity and behavioral distress in human newborns. Dev Psychobiol 1988;21:297–310.PubMedGoogle Scholar
  38. 38.
    Gunnar MR, Fisch RO, Korsvik S, Donhowe JM. The effects of circumcision on serum cortisol and behavior. Psychoneuroendocrinology 1981;6:269–75.PubMedGoogle Scholar
  39. 39.
    Gunnar MR, Malone S, Vance G, Fisch RO. Coping with aversive stimulation in the neonatal period: quiet sleep and plasma cortisol levels during recovery from circumcision. Child Dev 1985;56:824–34.PubMedGoogle Scholar
  40. 40.
    Gunnar MR, Malone S, Vance G, Fisch RO. Coping with aversive stimulation in the neonatal period: quiet sleep and plasma cortisol levels during recovery from circumcision. Child Dev 1985;56:824–34.PubMedGoogle Scholar
  41. 41.
    Spitz RA, Emde RN, Metcalf DR. Further prototypes of ego formation: a working paper from a research project on early development. Psychanal Stud Child 1970;25:417–41.Google Scholar
  42. 42.
    Stem E, Parmelee AH, Akiyama Y, Schultz MA, Wenner WH. Sleep cycle characteristics in infants. Pediatrics 1969;43:65–70.Google Scholar
  43. 43.
    Anders T, Roffivarg H. The effects of selective interruption and total sleep deprivation in the human newborn. Development Psychobiol 1973;6:79–89.Google Scholar
  44. 44.
    Gunnar MR, Fisch RO, Malone S. The effects of a pacifying stimulus on behavioral and adrenocortical responses to circumcision in the newborn. J Am Acad Child Psychiatry 1984;23:34–8.PubMedGoogle Scholar
  45. 45.
    Gunnar MR, Fisch RO, Korsvik S, Donhowe JM. The effects of circumcision on serum cortisol and behavior. Psychoneuroendocrinology 1981;6:269–75.PubMedGoogle Scholar
  46. 46.
    Emde RN, Harmon M, Metcalf D, Koenig KL, Wagonfeld S. Stress and neonatal sleep. Psychosom Med 1971;33:491–7.PubMedGoogle Scholar
  47. 47.
    Anders TF, Chalemian RJ. The effects of circumcision on sleep-wake states in human neonates. Psychosom Med 1974;36:174–9.PubMedGoogle Scholar
  48. 48.
    Marshall RE, Porter FL, Rogers AG, Moore J, Anderson B, Boxerman SB. Circumcision: II. Effects upon mother-infant interaction. Early Hum Dev 1982;7:367–74.PubMedGoogle Scholar
  49. 49.
    Dixon S, Snyder J, Holve R, Bromberger P. Behavioral effects of circumcision with and without anesthesia. J Dev Behav Peds 1984;5:246–50.Google Scholar
  50. 50.
    Howard CR, Howard FM, Weitzman ML. Acetaminophen analgesia in neonatal circumcision: the effect on pain. Pediatrics 1994;93:641–6.PubMedGoogle Scholar
  51. 51.
    Brackbill Y. Continuous stimulation and arousal level in infancy: effects of stimulus intensity and stress. Child Dev 1975;46:364–9.PubMedGoogle Scholar
  52. 52.
    Gunnar MR, Fisch RO, Malone S. The effects of a pacifying stimulus on behavioral and adrenocortical responses to circumcision in the newborn. J Am Acad Child Psychiatry 1984;23:34–8.PubMedGoogle Scholar
  53. 53.
    Gunnar MR, Malone S, Vance G, Fisch RO. Coping with aversive stimulation in the neonatal period quiet sleep and plasma cortisol levels during recovery from circumcision. Child Dev 1985;56:824–34.PubMedGoogle Scholar
  54. 54.
    Emde RN, Harmon RT, Metcalf D, Koenig KL, Wagonfeld S. Stress and neonatal sleep. Psychosom Med 1971;33:491–7.PubMedGoogle Scholar
  55. 55.
    Anders TF, Chalemian RT. The effects of circumcision on sleep-wake states in human neonates. Psychosom Med 1974;36:174–9.PubMedGoogle Scholar
  56. 56.
    Gunnar MR, Fisch RO, Korsvik S, Donhowe N. The effects of circumcision on serum cortisol and behavior. Psychoneuroendocrinology 1981;6:269–75.PubMedGoogle Scholar
  57. 57.
    Brackbill Y. Continuous stimulation and arousal level in infancy: effects of stimulus intensity and stress. Child Dev 1975;46:364–9.PubMedGoogle Scholar
  58. 58.
    Dixon S, Snyder J, Holve R, Bromberger P. Behavioral effects of circumcision with and without anesthesia. J Dev Behav Peds 1984;5:246–50.Google Scholar
  59. 59.
    Marshall RE, Porter FL, Rogers AG, Moore J, Anderson B, Boxerman SB. Circumcision: II. Effects upon mother-infant interaction. Early Hum Dev 1982;7:367–74.PubMedGoogle Scholar
  60. 60.
    Dixon S, Snyder J, Holve R, Bromberger P. Behavioral effects of circumcision with and without anesthesia. J Dev Behav Peds 1984;5:246–50.Google Scholar
  61. 61.
    Howard CR, Howard FM, Weitzman ML. Acetaminophen analgesia in neonatal circumcision: the effect on pain. Pediatrics 1994;93:641–6.PubMedGoogle Scholar
  62. 62.
    Basbaum AI. Memories of pain. Sci Med 1996;(Nov/Dec):22–31.Google Scholar
  63. 63.
    Davis M, Emory E. Sex differences in neonatal stress reactivity. Child Dev 1995;66:14–27.PubMedGoogle Scholar
  64. 64.
    Gunnar MR, Porter FL, Wolf CM, Rigatuso J, Larson MC. Neonatal stress reactivity: predictions to later emotional temperment. Child Dev 1995;66:1–13.PubMedGoogle Scholar
  65. 65.
    Ramsay DS, Lewis M. The effects of birth condition on infants’ cortisol response to stress. Pediatrics 1995;95:546–9.PubMedGoogle Scholar
  66. 66.
    Taddio A, Goldbach M, Ipp M, Stevens B, Koren G. Effect of neonatal circumcision on pain responses during vaccination in boys. Lancet 1995;345:291–2.PubMedGoogle Scholar
  67. 67.
    Taddio A, Katz J, Ilersich AL, Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lnncet 1997;349:599–403.Google Scholar
  68. 68.
    Taddio A, Goldbach M, Ipp M, Stevens B, Koren G. Effect of neonatal circumcision on pain responses during vaccination in boys. Lancet 1995;345:291–2.PubMedGoogle Scholar
  69. 69.
    Weisman SJ, Bernstein B, Schechter NL. Consequences of inadequate analgesia during painful procedures in children. Arch Pediatr Adolesc Med 1998;152:147–9.PubMedGoogle Scholar
  70. 70.
    Malone SM, Gunnar MR, Fisch RO. Adrenocortical and behavioral responses to limb restraint in human neonates. Dev Psychobiol 1985;18:435–46.PubMedGoogle Scholar
  71. 71.
    Schoen EJ, Fischell AA. Pain in neonatal circumcision. Clin Pediatr Phila 1991;30:429–32.PubMedGoogle Scholar
  72. 72.
    Marchette L, Main R, Redick E. Pain reduction during neonatal circumcision. Pediatr Nurs 1989;15:207–8,210.PubMedGoogle Scholar
  73. 73.
    Marchette L, Main R, Redick E, Bagg A, Leatherland J. Pain reduction interventions during neonatal circumcision. Nurs Res 1991;40:241–4.PubMedGoogle Scholar
  74. 74.
    Blass EM, Hoffmeyer LB. Sucrose as an analgesic for newborn infants. Pediatrics 1991;87:215–8.PubMedGoogle Scholar
  75. 75.
    Herschel M, Khoshnood B, Ellman C, Maydew N, Mittendorf R. Neonatal circumcision: randomized trial of sucrose pacifier for pain control. Arch Pediatr Adolesc Med 1998;152:279–84.PubMedGoogle Scholar
  76. 76.
    Gunnar MR, Connors J, Isensee J, Wall L. Adrenocortical activity and behavioral distress in human newborns. Dev Psychobiol 1988;21:297–310.PubMedGoogle Scholar
  77. 77.
    Mohan CG, Risucci DA, Casimir M, Gulrajani-LaCorte M. Comparison of analgesics in ameliorating the pain of circumcision. J Perinatol 1998;18:13–9.PubMedGoogle Scholar
  78. 78.
    Gunnar MR, Wsch RO, Malone S. The effects of a pacifying stimulus on behavioral and adrenocortical responses to circumcision in the newborn. J Am Acad Child Psychiatry 1984;23:34–8.PubMedGoogle Scholar
  79. 79.
    Gunnar MR, Fisch RO, Korsvik S, Donhowe JM. The effects of circumcision on serum cortisol and behavior. Psychoneuroendocrinology 1981;6:269–75.PubMedGoogle Scholar
  80. 80.
    Gunnar MR, Connors J, Isensee J, Wall L. Adrenocortical activity and behavioral distress in human newborns. Dev Psychobiol 1988;21:297–310.PubMedGoogle Scholar
  81. 81.
    Stang HJ, Snellman LW, Condon LM, Conroy MM, Liebo R, Brodersen, Gunnar MR. Beyond dorsal penile nerve block: a more humane circumcision. Pediatrics 1997;100(2): URL. http://www.pediatrics.org/cgi/content/full/l00/2/e3.
  82. 82.
    Blass EM, Hoffmeyer LB. Sucrose as an analgesic for newborn infants. Pediatrics 1991;87:215–8.PubMedGoogle Scholar
  83. 83.
    Allen KD, White DD, Walburn JN. Sucrose as an analgesic agent for infants during immunization injections. Arch Pediatr Adolesc Med 1996;150:270–4.PubMedGoogle Scholar
  84. 84.
    Blass EM, Hoffmeyer LB. Sucrose as an analgesic for newborn infants. Pediatrics 1991;87:215–8.PubMedGoogle Scholar
  85. 85.
    Wiswell TE. Circumcision: foreskin fact, foreskin fiction. Paper presented at Advances and Controversies in Clinical Pediatrics, San Francisco, California, May 17, 1997.Google Scholar
  86. 86.
    Baskin LS. Circumcision. In: Baskin U, Kogan BA, Duckett JW, eds. Handbook of Pediatric Urology. Philadelphia: Lippencott-Raven. 1997:1–9.Google Scholar
  87. 87.
    Howard CR, Howard FM, Weitzman ML. Acetaminophen analgesia in neonatal circumcision: the effect on pain. Pediahics 1994;93:641–6.Google Scholar
  88. 88.
    Wiswell TE. Circumcision circumspection. N Engl J Med 1997;336:1244–5.PubMedGoogle Scholar
  89. 89.
    Kirya C, Werthmann MW Jr. Neonatal circumcision and penile dorsal nerve block—a painless procedure. J Pediatr 1978;92:998–1000.PubMedGoogle Scholar
  90. 90.
    Poma PA. Painless neonatal circumcision. Int J Gynaecol Obstet 1980;18:308–9.PubMedGoogle Scholar
  91. 91.
    Maxwell LG, Yaster M, Wetzel RC, Niebyl JR. Penile nerve block for newborn circumcision. Obstet Gynecol 1987;70:415–9.PubMedGoogle Scholar
  92. 92.
    Williamson PS, Evans ND. Neonatal cortisol response to circumcision with anesthesia. Clin Pediatr Phila 1986;25:412–5.PubMedGoogle Scholar
  93. 93.
    Masciello AL. Anesthesia for neonatal circumcision: local anesthesia is better than dorsal penile nerve block. Obstet Gynecol 1990;75:834–8.PubMedGoogle Scholar
  94. 94.
    Holve RL, Bromberger PJ, Groveman HD, Klauber MR, Dixon SD, Snyder JM. Regional anesthesia during newborn circumcision. Effect on infant pain response. Clin Pediatr Phila 1983;22:813–8.PubMedGoogle Scholar
  95. 95.
    Williamson PS, Williamson ML. Physiologic stress reduction by a local anesthetic during newborn circumcision. Pediatrics 1983;71:36–40.PubMedGoogle Scholar
  96. 96.
    Stang HJ, Gunnar MR, Snellman L, Condon LM, Kestenbaum R. Local anesthesia for neonatal circumcision. Effects on distress and cortisol response. JAMA 1988;259:1507–11.PubMedGoogle Scholar
  97. 97.
    Spencer DM, Miller KA, O’Quin M, Tomsovic JP, Anderson B, Wong D, Williams WE. Dorsal penile nerve block in neonatal circumcision: chloroprocaine versus lidocaine. Am J Perinatol 1992;9:214–8.PubMedGoogle Scholar
  98. 98.
    Arnett RM, Jones JS, Horger EO 3d Effectiveness of 1% lidocaine dorsal penile nerve block in infant circumcision. Am J Obstet Gynecol 1990;163:1074–80.PubMedGoogle Scholar
  99. 99.
    Herschel M, Khoshnood B, Ellman C, Maydew N, Mittendorf R. Neonatal circumcision: randomized trial of sucrose pacifier for pain control. Arch Pediatr Adolesc Med 1998;152:279–84.PubMedGoogle Scholar
  100. 100.
    Butler-O’Hara M, LeMoine C, Guillet R. Analgesia for neonatal circumcision: a randomized controlled trial of EMLA cream versus dorsal penile nerve block. Pediatrics 1998;101(4): URL. http://www.pediatrics.org/cgi/content/full/101/4/e5.
  101. 101.
    Lander J, Brady-Fryer B, Metcalfe JB, Nazarali S, Muttitt S. Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision. JAMA 1997;278:2157–62.PubMedGoogle Scholar
  102. 102.
    Stang HJ, Snellman LW, Condon LM, Conroy MM, Liebo R, Brodersen, Gunnar MR. Beyond dorsal penile nerve block: a more humane circumcision. Pediatrics 1997;100(2): URL. http://www.pediatrics.org/cgi/content/full/l00/2/e3.
  103. 103.
    Williamson ML. Circumcision anesthesia: a study of nursing implications for dorsal penile nerve block. Pediatr Nurs 1997;23:59–43.PubMedGoogle Scholar
  104. 104.
    Holton ME. Comparison of newborn circumcision pain to calcaneal heel puncture pain: is newborn circumcision pain control clinically warranted? JAOA 1996;96:31–3.PubMedGoogle Scholar
  105. 105.
    Poma PA. Painless neonatal circumcision. Int J Gynaecol Obstet 1980;18:308–9.PubMedGoogle Scholar
  106. 106.
    Fontaine P, Dittberner D, Scheltema KE. The safety of dorsal penile nerve block for neonatal circumcision. J Farn Pract 1994;39:243–8.Google Scholar
  107. 107.
    Snellman LW, Stang HJ. Prospective evaluation of complications of dorsal penile nerve block for neonatal circumcision. Pediatrics 1995;95:705–8.PubMedGoogle Scholar
  108. 108.
    Lander J, Brady-Fryer B, Metcalfe JB, Nazarali S, Muttitt S. Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision. JAMA 1997;278:2157–62.PubMedGoogle Scholar
  109. 109.
    Butler-O’Hara M, LeMoine C, Guillet. Analgesia for neonatal circumcision: a randomized controlled trial of EMLA cream versus dorsal penile nerve block. Pediatrics 1998;101(4): URL. http://www.pediatrics.org/cgi/content/full/l0l/4/e5.
  110. 110.
    Sara CA, Lowry CJ. A complication of circumcision and dorsal nerve block of the penis. Anaesth Intensive Care 1985;13:79–82.PubMedGoogle Scholar
  111. 111.
    Berens R, Pontus SP Jr. A complication associated with dorsal penile nerve block. Reg Anesth 1990;15:309–10.PubMedGoogle Scholar
  112. 112.
    Mandel S. Methemoglobinemia following neonatal circumcision. JAMA 1989;261:702.PubMedGoogle Scholar
  113. 113.
    Toffler WL, Sinclair AE, White KA. Dorsal penile nerve block during newborn circumcision: under-utilization of a proven technique? J Am Board Fam Pract 1990;3:171–4.PubMedGoogle Scholar
  114. 114.
    Wiswell TE. Routine neonatal circumcision. Am Farn Physician 1990;42:1536–7.Google Scholar
  115. 115.
    Kaneko S, Bradley WE. Penile electrodiagnosis: penile peripheral innervation. Urology 1987;30:210–2.PubMedGoogle Scholar
  116. 116.
    Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol 1996;77:291–5.PubMedGoogle Scholar
  117. 117.
    Masciello AL. Anesthesia for neonatal circumcision: local anesthesia is better than dorsal penile nerve block. Obstet Gynecof 1990;75:834–8.Google Scholar
  118. 118.
    Cold CJ, Taylor JR. The prepuce. Br J Urol. In press.Google Scholar
  119. 119.
    Serour F, Cohen A, Mandelberg A, Mori J, Ezra S. Dorsal penile nerve block in children undergoing circumcision in a day-care surgery. Can J Anaesth 1996;43:954–8.PubMedGoogle Scholar
  120. 120.
    Serour F, Mori J, Barr J. Optimal regional anesthesia for circumcision. Anesth Analg 1994;79:129–31.PubMedGoogle Scholar
  121. 121.
    Serour F, Reuben S, Ezra S. Circumcision in children with penile block alone. J Urof 1995;153:474–6.Google Scholar
  122. 122.
    Mudge D, Younger JB. The effects of topical lidocaine on infant response to circumcision. J Nurse Midwifery 1989;34:335–40.PubMedGoogle Scholar
  123. 123.
    Weatherstone KB, Rasmussen LB, Erenberg A, Jackson EM, Claflin KS, Leff RD. Safety and efficacy of a topical anesthetic for neonatal circumcision. Pediatrics 1993;92:710–4.PubMedGoogle Scholar
  124. 124.
    Benini F, Johnston CC, Faucher D, Aranda JV. Topical anesthesia during circumcision in newborn infants. JAMA 1993;270:850–3.PubMedGoogle Scholar
  125. 125.
    Russell CT, Chaseling J. Topica1 anaesthesia in neonatal circumcision: a study of 208 consecutive cases. Aut Fum Physician 1996 Jan;(Suppl 1):S30–S34.Google Scholar
  126. 126.
    Taddio A, Stevens B, Craig K, Rastogi P, Ben-David S, Shennan A, Mulligan P, Koren G. Efficacy and safety of lidocaine-prilocaine cream for pain during circumcision. N Engl J Med 1997;336:1197–201.PubMedGoogle Scholar
  127. 127.
    Butler-O’Hara M, LeMoine C, Guillet. Analgesia for neonatal circumcision: a randomized controlled trial of EMLA cream versus dorsal penile nerve block. Pediatrics 1998;101(4): URL. http://www.pediatrics.org/cgi/content/full/l01/4/e5.
  128. 128.
    Lander J, Brady-Fryer B, Metcalfe JB, Nazarali S, Muttitt S. Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision. JAMA 1997;278:2157–62.PubMedGoogle Scholar
  129. 129.
    Mohan CG, Risucci DA, Casimir M, Gulrajani-LaCorte M. Comparison of analgesics in ameliorating the pain of circumcision. J Perinatol 1998;18:13–9.PubMedGoogle Scholar
  130. 130.
    Taddio A, Ohlsson A, Einarson TR, Stevens B, Koren G. A systematic review of lidocain-prilocain cream (EMLA) in the treatment of acute pain in neonates. Pediatrics 1998;101(2): URL. http://www.pediatrics.org/content/full/l0l/2/el.
  131. 131.
    Siddique NI, et al. A comparative study of topical eutetic mixture of local anesthetics (EMLA) cream and dorsal penile nerve block for circumcision in adult males. Reg Anesth 1997;22(2S):94.Google Scholar
  132. 132.
    Serour F, Mandelberg A, Zabeeda D, Mori J, Ezra S. Efficacy of EMLA cream prior to dorsal penile nerve block for circumcision in children. Acta Anaesthesiol Scand 1998;42:260–3.PubMedGoogle Scholar
  133. 133.
    Puthoff TD, Visconti JA, Tschampel MM. Use of EMLA prior to circumcision. Ann Pharmacotherapy 1996;30:1327–30.Google Scholar
  134. 134.
    Barreto J, Caballero C, Cubilla A. Penis. In: Sternberg SS, ed. Histology for Pathologists. New York: Raven Press, Ltd. 1992:721–30.Google Scholar
  135. 135.
    Taddio A, Stevens B, Craig K, Rastogi P, Ben-David S, Shennan A, Mulligan P, Koren G. Efficacy and safety of lidocaine-prilocaine cream for pain during circumcision. N Engl J Med 1997;336:1197–201.PubMedGoogle Scholar
  136. 136.
    Serour F, Mandelberg A, Zabeeda D, Mori J, Ezra S. Efficacy of EMLA cream prior to dorsal penile nerve block for circumcision in children. Acta Anaesthesiol Scand 1998;42:260–3.PubMedGoogle Scholar
  137. 137.
    Jones SK, Handfield-Jones S, Kennedy CT. Does EMLA reduce the discomfort associated with local-anesthetic infiltration? Clin Exp Dermatol 1990;15:177–9.PubMedGoogle Scholar
  138. 138.
    Mandel S. Methemoglobinemia following neonatal circumcision. JAMA 1989;261:702.PubMedGoogle Scholar
  139. 139.
    Tse S, Barrington K, Byme P. Methemoglobinemia associated with prilocaine use in neonatal circumcision. Am J Perinatology 1995;12:331–2.Google Scholar
  140. 140.
    Öizbek N, Sarikayalar F. Toxic methaemoglobinemia after circumcision. Eur J Pediatr 1993;152:80.Google Scholar
  141. 141.
    Prineas S, Wilkins BH, Halliday RJ. Circumcision blues. Med J Aust 1997;166:615.PubMedGoogle Scholar
  142. 142.
    Hall AH, Kulig KW, Rumack BH. Drug and chemical-induced methaemoglobinemia. Med Toxicol 1986;1:253–60.PubMedGoogle Scholar
  143. 143.
    Gazarian M, Taddio A, Klein J, Kent G, Koren G. Penile absorption of EMLA cream in piglets: implications for use of EMLA in neonatal circumcision. Biol Neonate 1995;68:334–41.PubMedGoogle Scholar
  144. 144.
    Nilsson A, et al. Inverse relationship between age dependent erythrocyte activity of methemoglobin reductase and prolocaine-induced methemoglobinemia during infancy. Br J Anaesth 1990;64:72–6.PubMedGoogle Scholar
  145. 145.
    Kumar AR, Dunn N, Naqvi M. Methemoglobinemia associated with prilocaine-lidocaine cream. Clin Pediatr Phila 1997;36:239–40.PubMedGoogle Scholar
  146. 146.
    Taddio A, Stevens B, Craig K, Rastogi P, Ben-David S, Shennan A, Mulligan P, Koren G. Efficacy and safety of lidocaine-prilocaine cream for pain during circumcision. N Engl J Med 1997;336:1197–201.PubMedGoogle Scholar
  147. 147.
    Russell CT, Chaseling J. Topica1 anaesthesia in neonatal circumcision: a study of 208 consecutive cases. Ausr Farn Physician 1996 Jan;(Suppl l):S30–S34.Google Scholar
  148. 148.
    Lenhart JG, Lenhart NM, Reid A, Chong BK. Local anesthesia for circumcision: which technique is most effective. J Am Board Farn Pract 1997:10:13–9.Google Scholar
  149. 149.
    Masciello AL. Anesthesia for neonatal circumcision: local anesthesia is better than dorsal penile nerve block. Obstet Gynecol 1990;75:834–8.PubMedGoogle Scholar
  150. 150.
    Lander J, Brady-Fryer B, Metcalfe JB, Nazarali S, Muttitt S. Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision. JAMA 1997;278:2157–62.PubMedGoogle Scholar
  151. 151.
    Hardwick-Smith S, Mastrobattista JM, Wallace PA, Ritchey ML. Ring block for neonatal circumcision. Obstetr Gynecol 1998;91:930–4.Google Scholar
  152. 152.
    Pinkham EW, Stevenson AW. Unusual reactions to local anesthesia: gangrene of the prepuce. U S Armed Forces Med J 1958;9:120–2.PubMedGoogle Scholar
  153. 153.
    Stinson JM. Impotence and adult circumcision. J Nut1 Med Assoc 1973;65:161.Google Scholar
  154. 154.
    Irwin MG, Cheng W. Comparison of subcutaneous ring block of the penis with caudal epidural block for post-circumcision analgesia in children. Anaesth Intensive Care 1996;24:365–7.PubMedGoogle Scholar
  155. 155.
    Malone SM, Gunnar MR, Elsch RO. Adrenocortical and behavioral responses to limb restraint in human neonates. Dev Psychobiol 1985;18:435–46.PubMedGoogle Scholar
  156. 156.
    Heitsch G. Swaddling eases circumcision. AAP News 1997;13(7):3.Google Scholar
  157. 157.
    Stang HJ, Snellman LW, Condon LM, Conroy MM, Liebo R, Brodersen, Gunnar MR. Beyond dorsal penile nerve block a more humane circumcision. Pediatrics 1997;100(2): URL. http://www.pediatric.org/cgi/content/full/100/2/e3.
  158. 158.
    Gunnar MR, Malone S, Vance G, Hsch RO. Coping with aversive stimulation in the neonatal period quiet sleep and plasma cortisol levels during recovery from circumcision. Child Dev 1985;56:824–34.PubMedGoogle Scholar
  159. 159.
    Gunnar MR, Rsch RO, Malone S. The effects of a pacifying stimulus on behavioral and adrenocortical responses to circumcision in the newborn. J Am Acad Child Psychiatry 1984;23:34–8.PubMedGoogle Scholar
  160. 160.
    Shechet J, Fried SM. Use of the Mogen clamp for neonatal circumcision. Am Fam Physician 1997;55:46.PubMedGoogle Scholar
  161. 161.
    Shechet J, Fried SM. Ritual circumcision and natural healing. Contemporary Pediatrics 1997;14(4):188.Google Scholar
  162. 162.
    Shechet J, Fried SM, Tanenbaum B. Local anesthesia for infants undergoing circumcision. JAMA 1998;279;1170–1.Google Scholar
  163. 163.
    “The Clinically Proven Mogen Circumcision Instruments.” Mogen Circumcision Instruments Ltd. Brooklyn, New York.Google Scholar
  164. 164.
    DeSilva H. Pediatric Academic Societies, cited in Childs ND. Physician’s choice of clamp may cause more pain. Pediatric News 1997;31(8):40.Google Scholar
  165. 165.
    Stang HJ, Snellman LW. Circumcision practice patterns in the United States. Pediatrics 1998;101(6): URL. http://www.pediatrics.org/cgi/content/full/l0l/6/e5.
  166. 166.
    Herschel M, Khoshnood B, Ellman C, Maydew N, Mittendorf R. Neonatal circumcision: randomized trial of sucrose pacifier for pain control. Arch Pediutr Adolesc Med 1998;152:279–84.Google Scholar
  167. 167.
    Butler-O’Hara M, LeMoine C, Guillet. Analgesia for neonatal circumcision: a randomized controlled trial of EMLA cream versus dorsal penile nerve block. Pediutrics 1998;101(4): URL. http://www.pediatrics.org/cgi/content/full/l0l/4/e5.
  168. 168.
    Lander J, Brady-Fryer B, Metcalfe JB, Nazarali S, Muttitt S. Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision. JAMA 1997;278:2157–62.PubMedGoogle Scholar
  169. 169.
    Van Howe RS, Cold CJ. Local anesthesia for infants undergoing circumcision. JAMA 1998;279:1170.PubMedGoogle Scholar
  170. 170.
    Mohan CG, Risucci DA, Casimir M, Gulrajani-LaCorte M. Comparison of analgesics in ameliorating the pain of circumcision. J Perinutol 1998;18:13–9.Google Scholar
  171. 171.
    Lenhart JG, Lenhart NM, Reid A, Chong BK. Local anesthesia for circumcision: which technique is most effective. JAm Board Fam Pract 1997:10:13–9.Google Scholar
  172. 172.
    Masciello AL. Anesthesia for neonatal circumcision: local anesthesia is better than dorsal penile nerve block. Obstet Gynecol 1990;75:834–8.PubMedGoogle Scholar
  173. 173.
    Holder KJ, Peutrell JM, Weir PM. Regional anaesthesia for circumcision. Subcutaneous ring block of the penis and subpubic penile block compared. Eur J Anuesthesiol 1997;14:495–8.Google Scholar
  174. 174.
    Weiss GN. Local anesthesia for neonatal circumcision. JAMA 1988;260:637–8.PubMedGoogle Scholar
  175. 175.
    Weiss GN, Weiss EB. A perspective on controversies over neonatal circumcision. Clin Pediutr Phila 1994;33:726–30.Google Scholar
  176. 176.
    Weiss C. Does circumcision of the newborn require an anesthetic? Clin Pediatr Phila 1968;7:128–9.PubMedGoogle Scholar
  177. 177.
    Gamy T. Circumcision: a survey of fees and practices. OBG Management (October 1994):34–6.Google Scholar
  178. 178.
    Wellington N, Rieder MJ. Attitudes and practices regarding analgesia for newborn circumcision. Pediatrics 1993;92:541–3.PubMedGoogle Scholar
  179. 179.
    Ryan CA, Finer NN. Changing attitudes and practices regarding local analgesia for newborn circumcision. Pediatrics 1994;94:230–3.PubMedGoogle Scholar
  180. 180.
    Fontaine P. Local anesthesia for neonatal circumcisions: are family practice residents likely to use it? Fum Med 1990;22:371–5.Google Scholar
  181. 181.
    Toffler WL, Sinclair AE, White KA. Dorsal penile nerve block during newborn circumcision: under-utilization of a proven technique? J Am Board Fum Pruct 1990;3:171–4.Google Scholar
  182. 182.
    Ferguson KJ, Caplan RM, Williamson PS. Factors associated with behavior change in family physicians after ME presentation. J Med Educ 1984;59:662–6.PubMedGoogle Scholar
  183. 183.
    Howard CR, Howard FM, Garfunkel LC, de Blieck EA, Weitzman M. Neonatal circumcision and pain relief: current training practices. Pediutrics 1998;101:423–8.Google Scholar
  184. 184.
    Stang HJ, Snellman LW. Circumcision practice patterns in the United States. Pediatrics 1998;101(6): URL. http://www.pediatrics.org/cgi/content/full/101/6/e5.
  185. 185.
    Holly EA, Palefsky JM. Factors related to risk of penile cancer: new evidence from a study in the Pacific Northwest. J Nutl Cuncer Inst 1993;85:2–4.Google Scholar
  186. 186.
    Maden C, Sherman KJ, Beckmann AM, Hislop TG, Teh CZ, Ashley RL, Daling JR. History of circumcision, medical conditions, and sexual activity and risk of penile cancer. J Nutl Cuncer Inst 1993;85:19–24.Google Scholar
  187. 187.
    Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States: prevalence, prophylactic effects, and sexual practices, and sexual practice. JAMA 1997;277:1052–7.PubMedGoogle Scholar
  188. 188.
    Price C. Male circumcision: an ethical and legal affront. Bull Med Ethics 1997;128:13–9.PubMedGoogle Scholar
  189. 189.
    Van Howe RS. Variations in penile appearance and findings: a prospective study. Br J Urol 1997;80:776–82.PubMedGoogle Scholar
  190. 190.
    Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol 1996;77:291–5.PubMedGoogle Scholar
  191. 191.
    Anand KJS, Hickey PR. Pain and its effects in the human neonate and fetus. N Engl J Med 1987;317:1321–9.PubMedGoogle Scholar
  192. 192.
    Wiswell TE. Circumcision circumspection. N Engl J Med 1997;336:1244–5.PubMedGoogle Scholar
  193. 193.
    Wiswell TE. Circumcision circumspection. N Engl J Med 1997;336:1244–5.PubMedGoogle Scholar
  194. 194.
    Lander J, Brady-Fryer B, Metcalfe JB, Nazarali S, Muttitt S. Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision. JAMA 1997;278:2157–62.PubMedGoogle Scholar
  195. 195.
    Butler-O’Hara M, LeMoine C, Guillet R. Analgesia for neonatal circumcision: a randomized controlled trial of EMLA cream versus dorsal penile nerve block. Pediatrics 1998;101(4): URL. http://www.pediatrics.org/cgi/conten/full/101/4/e5.
  196. 196.
    Lenhart JG, Lenhart NM, Reid A, Chong BK. Local anesthesia for circumcision: which technique is most effective. J Am Board Fam Pract 1997:10:13–9.PubMedGoogle Scholar
  197. 197.
    Cold CJ, Van Howe RS, Storms MR. Anesthesia for neonatal circumcision. J Am Board Fam Pract 1997;10:310–1.PubMedGoogle Scholar
  198. 198.
    Taddio A, Goldbach M, Ipp M, Stevens B, Koren G. Effect of neonatal circumcision on pain responses during vaccination in boys. Lancet 1995;345:291–2.PubMedGoogle Scholar
  199. 199.
    Taddio A, Katz J, Ilersich AL, Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet 1997;349:599–603.PubMedGoogle Scholar
  200. 200.
    Van Howe RS. Neonatal circumcision. Lancet 1997;349:1257.PubMedGoogle Scholar
  201. 201.
    Warren J. Circumcision. Lancet 1995;345:927.PubMedGoogle Scholar
  202. 202.
    Fleiss PM. Circumcision. Lancet 1995;345:927.PubMedGoogle Scholar
  203. 203.
    Weisman SJ, Bernstein B, Schechter NL. Consequences of inadequate analgesia during painful procedures in children. Arch Pediatr Adolesc Med 1998;152:147–9.PubMedGoogle Scholar
  204. 204.
    Hardwick-Smith S, Mastrobattista JM, Wallace PA, Ritchey ML. Ring block for neonatal circumcision. Obstetr Gynecol 1998;91:930–4.Google Scholar
  205. 205.
    Weiss GN. Local anesthesia for neonatal circumcision. JAMA 1988;260:637–8.PubMedGoogle Scholar
  206. 206.
    Weiss GN, Weiss EB. A perspective on controversies over neonatal circumcision. Clin Pediatr Phila 1994;33:726–30.PubMedGoogle Scholar
  207. 207.
    Toffler WL, Sinclair AE, White KA. Dorsal penile nerve block during newborn circumcision: under-utilization of a proven technique? J Am Board Fam Pract 1990;3:171–4.PubMedGoogle Scholar
  208. 208.
    Wellington N, Rieder MJ. Attitudes and practices regarding analgesia for newborn circumcision. Pediatrics 1993;92:541–3.PubMedGoogle Scholar
  209. 209.
    Stang W, Snellman LW. Circumcision practice patterns in the United States. Pediatrics 1998;101(6): URL. http://www.pediatrics.org/cgi/content/full/10l/6/e5.
  210. 210.
    Poland RL, Roberts RJ, Gutierrez-Mazorra JF, Fonkalsrud EW. The American Academy of Pediatrics, Committee on the Fetus and Newborn, Committee on Drugs, Section on Anesthesiology, Section on Surgery. Neonatal anesthesia. Pediatrics 1987;80:446.Google Scholar
  211. 211.
    Australasian Association of Paediatric Surgeons. Guidelines for Circumcision. Hersion, Queensland, Australia. April 1996.Google Scholar
  212. 212.
    Serour F, Cohen A, Mandelberg A, Mori J, Ezra S. Dorsal penile nerve block in children undergoing circumcision in a day-care surgery. Can J Anaesth 1996;43:954–8.PubMedGoogle Scholar
  213. 213.
    Australasian Association of Paediatric Surgeons. Guidelines for Circumcision. Hersion, Queensland, Australia. April 1996.Google Scholar
  214. 214.
    Lenhart JG. Anesthesia for neonatal circumcision. J Am Board Fam Pract 1997;10:311.Google Scholar
  215. 215.
    Van Howe RS. Anesthesia for neonatal circumcision: who benefits? J Pre Perinatal Psycho1 Health 1997;12(1):3–18.Google Scholar
  216. 216.
    Maimonides M. The Guide for the Perplexed. New York: Dover Publications. 1956:378–9.Google Scholar

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© Kluwer Academic / Plenum Publishers, New York 1999

Authors and Affiliations

  • Robert S. Van Howe

There are no affiliations available

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