One of the first things most little boys in the U.S. experience is something they'll never remember - circumcision - but that doesn't mean it isn't a painful experience. The debate over whether infants feel pain has ended, and the positive conclusion is catching up with obstetrical, pediatric and family physician training programs, 97 percent of which now learn effective pain relief techniques for circumcision. Just 10 years ago, only 71 percent learned how to ease pain during the brief surgical procedure.
"This is a large leap ahead in how physicians are trained to perform circumcisions, which at 1 million annually, is the most common surgical procedure," said Daniel Yawman, M.D., M.P.H., a pediatrician at Golisano Children's Hospital at Strong and Rochester General Hospital. Yawman, also a clinical instructor at the University of Rochester Medical Center, is the author of a study on the subject in Ambulatory Pediatrics today. "There is no reason a newborn should have to endure the pain of circumcision without a local or topical anesthetic."
Based upon the overwhelming evidence of the safety and benefit of effective analgesia, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics released recommendations since 1999 calling for the universal use of local or topical anesthetics to provide pain relief for neonatal circumcision.
A previous study on circumcision training techniques, which shared author Cynthia Howard, M.D., M.P.H., associate professor of pediatrics at the University of Rochester Medical Center and pediatric director of the mother-baby unit at Rochester General Hospital, was published in 1998, prior to the new pain relief recommendations.
The two most effective and most commonly used pain relief techniques are the dorsal penile nerve block and the subcutaneous ring block. Both techniques involve the injection of the painkiller lidocaine at the base of the penis which decreases pain sensation prior to circumcision. Topical anesthetic creams are less effective but they are safe and do provide some pain relief. Any of these techniques can be used in combination with the Mogen clamp, the Gomco clamp and the Pastibell method, the three most common surgical methods of circumcision.
"The decision whether or not to have their baby boy circumcised is a decision that parents must make after weighing the risks and benefits of the procedure. If parents decide that they would like to have their baby boy circumcised, it is the duty of the physician to make the procedure as painless as possible," Yawman said. "For more than 100 years, physicians have been talking about using pain relief during circumcision, and it's encouraging that the next generation of doctors is learning how to make circumcision more comfortable for their patients."