Circumcision and anesthesia – does it always work?

Australia: opinion article: infant circumcision unethical. violates patient rights.

anesthesia: does it always work? should surgery be continued even if the numbing agent fails? what is torture?

In this research study, 11 male newborns were circumcised with a local dorsal penile nerve block, and 13 controls were circumcised without anesthetic. When the adrenal cortisol levels were compared, response to surgery was not significantly reduced by the administration of lidocaine.

Some doctors use EMLA cream as an anesthetic. Not only is EMLA cream less effective than a lidocaine injection, but the manufacturer’s insert warns against its use on infants and on the genitals of children:

http://community.babycenter.com/post/a31227137/help_inform_co_worker

The following studies are regarding neonatal circumcision pain management:

“Circumcision is a painful procedure that many newborn males undergo in the first few days after birth. Interventions are available to reduce pain at circumcision; however, many newborns are circumcised without pain management. Adverse effects included gagging, choking, and emesis (vomiting) in placebo/untreated groups… None of the studied interventions completely eliminated the pain response to circumcision.” http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004217.pub2/abstract
“This study confirms that circumcision of the newborn causes severe and persistent pain. Acetaminophen was not found to ameliorate either the intra-operative or the immediate postoperative pain of circumcision…” http://pediatrics.aappublications.org/content/93/4/641.short
“Compared with baseline, all newborns experienced pain as evidenced by increased heart rate of an average of 40 beats per minute, decreased oxygen saturation of 3%, and more facial actions indicative of pain during all phases of the procedure.” http://jama.ama-assn.org/content/270/7/850.short
“…If untreated, the pain of circumcision causes both short and long term changes in infant behaviours… No single agent has been demonstrated to ameliorate pain for all infants undergoing circumcision.” http://www.ingentaconnect.com/content/adis/ped/2001/00000003/00000002/art00003

“…NIPS scores in patients circumcised without anesthesia indicated severe pain.” http://pediatrics.aappublications.org/content/101/4/e5.short

“Training with regard to pain relief is clearly inadequate for what remains a common surgical procedure in the United States. Given the overwhelming evidence that neonatal circumcision is painful and the existence of safe and effective anesthesia/analgesia methods, residency training in neonatal circumcision should include instruction in pain relief techniques.” http://www.pediatricsdigest.mobi/content/101/3/423.short

“The evidence suggests that early experiences with pain are associated with altered pain responses later in infancy.” http://www.ingentaconnect.com/content/adis/ped/2005/00000007/00000004/art00004
“Circumcised infants showed a stronger pain response to subsequent routine vaccination than uncircumcised infants. Among the circumcised group, preoperative treatment with Emla attenuated the pain response to vaccination. We recommend treatment to prevent neonatal circumcision pain.” http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2896%2910316-0/fulltext
“Thus neonatal circumcision may affect pain response several months after the event.” http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2895%2990278-3/abstract

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