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Arch Pediatr Adolesc Med. 2000 Jun;154(6):620-3.

Combined analgesia and local anesthesia to minimize pain during circumcision.

Author information

1
Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada. anna.taddio@sickkids.on.ca

Abstract

BACKGROUND:

Pain of circumcision is only partially relieved by single modalities, such as penile nerve block, lidocaine-prilocaine cream, and sucrose pacifiers.

OBJECTIVE:

To assess the effectiveness of a combination of interventions on the pain response of infants undergoing circumcision.

METHODS:

Cohort study. Group 1 included infants circumcised using the Mogen clamp and combined analgesics (lidocaine dorsal penile nerve block, lidocaine-prilocaine, acetaminophen, and sugar-coated gauze dipped in grape juice). Group 2 included infants circumcised using the Gomco clamp and lidocaine-prilocaine. Infants were videotaped during circumcision, and pain was assessed using facial activity scores and percentage of time spent crying.

RESULTS:

There were 57 infants in group 1 and 29 infants in group 2. Birth characteristics did not differ between groups. Infants in group 1 were older than infants in group 2 (17 days vs 2 days) (P < .001). The mean duration of the procedure was 55 seconds and 577 seconds for infants in group 1 and 2, respectively (P < .001). Facial action scores and percentage of time spent crying were significantly lower during circumcision for infants in group 1 (P < .001). The percentage of time spent crying was 18% and 40% for infants in groups 1 and 2, respectively. No adverse effects were observed in infants in group 1; 1 infant in group 2 had a local skin infection.

CONCLUSIONS:

Infants circumcised with the Mogen clamp and combined analgesia have substantially less pain than those circumcised with the Gomco clamp and lidocaine-prilocaine cream. Because of the immense pain during circumcision, combined local anesthesia and analgesia using the Mogen clamp should be considered.

PMID:
10850512
DOI:
10.1001/archpedi.154.6.620
[Indexed for MEDLINE]

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