Abstract
Objective:
The purpose of this investigation was to compare the effectiveness of dorsal penile nerve block and topical lidocaine–prilocaine anesthesia techniques for pain relief during circumcision.
Methods:
In total, 18 healthy term newborn males were divided based on anesthesia. The topical lidocaine–prilocaine group had six males undergoing circumcision and three males undergoing a sham procedure. The dorsal penile nerve block group had six males undergoing circumcision and three males undergoing a sham procedure. The procedures were videotaped and viewed by 90 noninvestigator reviewers who scored the infants' pain using the Neonatal Infant Pain Scale and a numeric pain scale. Statistical analysis utilized a P-value of <0.05 as significant.
Results:
The median Neonatal Infant Pain Scale and numeric pain scores were significantly lower in the dorsal penile nerve block group than in the topical lidocaine–prilocaine group or the sham group (Neonatal Infant Pain Scale: 1.0 (range 0–6) versus 6.0 (range 2–6) versus 4.0 (range 0–6), P<0.001, respectively; numeric pain scale: 2.0 (range 0–10) versus 8.0 (range 1–10) versus 4.0 (range 0–10), P<0.001, respectively). In the sham group, procedures with the dorsal penile nerve block had significantly lower pain scores than those with topical lidocaine–prilocaine (Neonatal Infant Pain Scale: 1.0 (range 0–6) versus 5.0 (range 2– 6), P<0.001; numeric pain scale: 1.0 (0–8) versus 6.0 (range 0–10), P<0.001). When reviewers were divided by medical background, gender or parental status, no differences in pain scores were observed.
Conclusion:
The dorsal penile nerve block anesthesia technique for newborn male circumcision was significantly more effective for pain relief than topical lidocaine–prilocaine.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Lerman SE, Liao JC . Neonatal circumcision. Pediatr Clin N Am 2001; 48: 1539–1557.
Moses S, Bailey RI, Ronald AR . Male circumcision: assessment of health benefits and risks. Sex Trans Infect 1998; 74: 368–373.
American Academy of Pediatrics. Task Force on Circumcision. Circumcision Policy Statement. Pediatrics 1999; 103: 686–693.
Kaplan GW . Circumcision: an overview. Curr Probl Pediatr 1977; 7: 3–33.
Litman RS . Anesthesia and analgesia for the newborn circumcision. Obstet Gynecol Survey 2001; 56: 114–117.
Anand KJ, International Evidence-Based Group for Neonatal Pain. Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med 2001; 155: 173–180.
Butler-O'Hara M, LeMoine C, Gullet R . Analgesia for circumcision: a randomized controlled trial of EMLA cream versus dorsal penile nerve block. Pediatrics 1998; 101: 5-DOI: 10.1542/peds.101.4e5.
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: 2157–2162.
Holliday MA, Pinckert TL, Kiernan SC, Kunos I, Angelus P, Keszler M . Dorsal penile nerve block versus topical placebo for circumcision in low-birth-weight neonates. Arch Pediatr Adolesc Med 1999; 153: 476–480.
Brady-Fryer B, Wiebe N, Lander J . Pain relief for neonatal circumcision. Cochrane Database Syst Rev 2004 Issue 3. Art. No.:CD004217.pub2.DOI:10.1002/14651858.CD004217.pub2.
Benini F, Johnston CC, Faucher D, Aranda JV . Topical anesthesia during circumcision in newborn infants. JAMA 1993; 270: 850–854.
Taddio A, Stevens B, Craig K, Rastogi P, Ben-David S, Shennan A et al. Efficacy and safety of lidocaine-prilocaine cream for pain during circumcision. N Engl J Med 1997; 336: 1197–1201.
Calobrisi SD, Drolet BA, Esterly NB . Petechial eruption after the application of EMLA cream. Pediatrics 1998; 101: 471–473.
Taddio A, Pollock N, Gilbert-MacLeod C, Ohlsson K, Koren G . Combined analgesia and local anesthesia to minimize pain during circumcision. Arch Pediatr Adolesc Med 2000; 154: 620–623.
Hudson-Barr D, Capper-Michel B, Lambert S, Palermo TM, Morbeto K, Lombardo S . Validation of the Pain Assessment in Neonates (PAIN) scale with the Neonatal Infant Pain Scale (NIPS). Neonatal Network 2002; 21: 15–21.
Lawrence J, Alcock D, McGrath P, Kay J, MacMurray SB, Dulberg C . The development of a tool to assess neonatal pain. Neonatal Network 1993; 12: 59–66.
Shah VS, Taddio A, Bennett S, Speidel BD . Neonatal pain response to heel stick versus venepuncture for routine blood sampling. Arch Dis Child Fetal Neonatal Ed 1997; 77: F143–F144.
Khan KS, Chien PF . Evaluation of a clinical test. I: assessment of reliability. BJOG 2001; 108: 562–567.
Serour F, Mandelberg A, Zabeeda D, Mori J, Ezra S . Efficiency of ELMA cream prior to dorsal penile nerve block for circumcision in children. Acta Anaesthesiol Scand 1998; 42: 260–263.
Robinson ME, Wise EA . Gender bias in the observation of experimental pain. Pain 2003; 104: 259–264.
Van Howe RS . Pain relief for neonatal circumcision: serious design flaws? Pediatrics 1999; 103: 196–197.
Miller FG . Sham surgery: an ethical analysis. Am J Bioeth 2003; 3: 41–48.
Gerbert B, Berg-Smith S, Mancuso M, Caspers N, Danley D, Herzig K et al. Video study of physician selection: preferences in the face of diversity. J Fam Pract 2003; 52: 552–559.
Acknowledgements
We are indebted to the parents for allowing their infants to participate in our study, to the video reviewers and to Lester Lowe Ward III for his assistance with data.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Garry, D., Swoboda, E., Elimian, A. et al. A video study of pain relief during newborn male circumcision. J Perinatol 26, 106–110 (2006). https://doi.org/10.1038/sj.jp.7211413
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.jp.7211413
Keywords
This article is cited by
-
Neonatal Infant Pain Scale in assessing pain and pain relief for newborn male circumcision
International Journal of Impotence Research (2023)
-
Management of pain in newborn circumcision: a systematic review
European Journal of Pediatrics (2021)
-
Analgesia for infants’ circumcision
Italian Journal of Pediatrics (2013)