Infant Circumcision: Can they really feel it?
As an American living in the twentieth century, I can state with certainty that one of the biggest things we pride ourselves on is our technological superiority and advances in healthcare. That is why I was so shocked to learn that most infants who receive circumcisions in the United States go under the knife with no anesthesia of any kind. The explanation for this, although archaic, is understandable from a medical standpoint. The main reason that it took so long for someone to test these theories is because there are very rarely any complications with infant circumcisions, so the medical community looked at the problem with the attitude of if its not broke, dont fix it. Luckily though for our future children someone finally did take the chance to try to prove the medical community wrong and disprove the objections for anesthesia.
One of the reasons that many doctors dont use anesthesia is because they believe that the application of anesthesia would be medically harmful for the baby because of the types of drugs that would be necessary to use. Although a valid concern, this belief has been proven by scientists to be false. In two different Clinical trials where lidocaine was injected into the penis of the infants, there was no sign of bleeding, swelling or hematomas at the site of the injection after the surgery was completed. As for the babys reaction to the drug, there was no sign of post operative vital sign abnormalities, no skin changes, no depressed spinal reflex activity, and no delayed recovery of penile sensation (Williamson 5). All of the babys did quite well with the medication and there is not expected to be any future signs of complications.
Another strong belief that has actually been around since early times is that infants wont remember pain or cannot really feel anything because of underdeveloped nerve pathways. This belief is understandable because the doctors had no way of knowing that infants could feel pain since there was no basis for comparison. Once they did finally compare these infants to ones who were anesthized, the difference was so astonishing that one group of researchers actually stopped their experiment midway because they needed no more data. The conclusion that they came to is that infants can and do feel the pain of the circumcisions. Although the infants vital signs in the two groups were not to statistically different, the difference in crying rates and types were dramatic. All 10 of the unanesthetized group cried in a high pitched, screeching manner typical of a newborn pain cry from the beginning of the glans dissection process until the dressing was applied at the end of the surgery, except for a 30 second interval just prior to removal of the Gomco clamp. Six of the anesthetized group cried briefly during the application of the Gomco clamp in a mid-to-low pitch similar to the manner in which all infants cried during application of the restraints. Nine of the infants who had been given the DPNB (the anesthesia) actually slept throughout the circumcision (Williamson 4). There was also no jitteriness in any of the babies who were given the DPNB, but there was jitteriness in the unanesthetized infants during and after the operation. This also debunks the third myth that the shot of the lidocane would be more painful than the actual procedure. Although the infants did cry during the application and had a heart rate of 35.6 beats above the baseline, this in no way compares to the high pitched wailing of the drug free newborns during the separation process whose heart rate was 53 beats above the baseline compared to the drug group whose rate was only 20.2 above.
I believe this evidence conclusively shows that infants due in fact feel pain during routine circumcisions and the American Medical Association seems to also agree. In the recent issue of the Journal of the AMA researchers urged Physicians to routinely apply ring block anesthesia before performing the operation. The ring block method, which in tails the lidocane being applied in a band around the shaft of the penis, was found to be the superior method for blocking pain over the widely used dorsal penile nerve block and the use of a topical cream. Hopefully as more studies are done doctors and nurses will realize the importance of using some sort of pain blocker for the safety of the infant and of our own consciences.
1.Ring Block Anesthesia wins the kindest cut of all. Vol.34, Medical Post, 01-27-1998, pp 40. This article was very informative and was interesting because it already operated under the assumption that infants do feel the pain of the circumcision so instead of focusing on that it instead concentrated on the different types of anesthesia and which worked the best.
2.Williamson, Marvel L., Circumcision anesthesia: a study of nursing implications for dorsal penile nerve block. Vol. 23, Pediatric Nursing, 01-11-1997, pp 59 (5).
This article helped me by going very in depth about the study that was done and explaining the major differences between the reactions of newborns who have the procedure done either with or without lidocane.