Anesthetics are the best way to ease circumcision (search) pain for male newborns, according to a new study.
The finding comes from researchers including Canada's Barbara Brady-Fryer, RN, of the Child Health Program at Stollery Children's Hospital-Capital Health in Edmonton, Alberta.
Circumcision is an elective surgical procedure performed on more than 1 million baby boys in the U.S. per year. It involves removing the foreskin, a fold of skin covering the rounded tip of the penis.
Many newborn males are circumcised without any pain relief during or after the procedure. However, many health experts and medical organizations, including the American Academy of Pediatrics (search), recommend pain management practices for circumcision.
Brady-Fryer and colleagues reviewed 35 studies on pain relief and circumcision that included a total of almost 2,000 baby boys.
The researchers found that dorsal penile nerve block (search), an injection of the painkiller lidocaine (search), did the best job of relieving pain during circumcision.
The shot helped the infants by improving their pain scores, cutting crying time by 54 percent, and lowering heart rate by 30 beats per minute, compared with a placebo or no treatment.
A similar technique called ring block (search) may be as effective; however, it was only compared with dorsal penile nerve block in one trial, which had 27 patients. In that study, crying time and heart rate were similar with both shots.
If avoiding injections is a priority, a water-based lidocaine cream (search) might be an option. Tests showed that the cream helped relieve circumcision pain, but not as much as the dorsal penile nerve block. The cream cut crying time by 15 percent and lowered heart rate by 15 beats per minute.
Circumcision Pain Remedies Not Perfect
However, neither method completely eliminated pain. Both circumcision pain relief strategies also require a little advance planning.
After injection, dorsal penile nerve block takes five minutes to become effective. The cream has a longer wait time of 60 minutes and may wash off if the baby urinates during that hour. That's all the more reason for parents to discuss circumcision pain relief with their doctor before the procedure.
Looking for a drug-free alternative?
The researchers didn't find any strategies to recommend. Trials showed that sugar pills and soothing music did not reduce pain related to circumcision.
Likewise, there was no firm support for acetaminophen as circumcision pain reliever.
By Miranda Hitti; reviewed by Charlotte E. Grayson, MD
SOURCES: Brady-Fryer, B. The Cochrane Collaboration, October 2004. Health Behavior News Service.
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