CIRCUMCISION: USE OF LOCAL ANESTHESIA

CIRCUMCISION: USE OF LOCAL ANESTHESIA

Dear Sumner:

I have a family from Berkeley that I’d like you to see. They wish to have their son circumcised, but they want to be sure he will not experience any pain during the procedure. They have searched the internet for information about the risks of local anesthesia in a newborn as well as the possible physical and psychological trauma which might result if no anesthetic is used. His father wishes to watch the procedure being done. Will this be OK with you? They will be calling your office for an appointment.

Dear Bob:

There is little argument that the use of some form of local anesthesia in the newborn helps decrease the pain level during circumcision. I addressed this issue with the family as well as the possibility, albeit very rare, of an allergic reaction to the anesthetic. With their own religious backgrounds, they were already well aware of the use of wine to sedate the child (the mainstay for religious circumcisions for centuries!). We also talked about the use of topical anesthetic cream. (To be effective, it should be applied at least one hour before the procedure is started.) After much discussion, weighing the pros and cons (including potential risks) of local anesthesia, all parties involved (parents and doctor--infant Josh didn’t offer his opinion), decided that local anesthesia would provide the most effective method off minimizing the discomfort of the circumcision.

Re their desire to be present during the procedure, I pointed out very clearly that I wanted to give my full attention to their child. I.e. I do not want to have to divert any of my attention to either of them, should they become distressed during the procedure. They both expressed VERY strong feelings about being in the room, and promised to be “good.” Using a very tiny needle, I injected less than 1cc. of 0.5% lidocaine circumferentially in the area just proximal to the foreskin. Josh was quiet and his parents breathed a big sigh of relief. (As did I!)

Bob, I’d like to share another story of an older boy, just to point out that anesthesia is not always necessary. Mark, age 4, came to me for the release of adhesions of the foreskin to the glans (head of the penis). Given his age and level of concern of his father (although the boy himself was pretty relaxed about the whole thing), I planned on using a local anesthetic to try to minimize the trauma (mainly for the parents). When the time came to proceed, since Mark was not very enthusiastic about having a needle stuck in his penis, I thought I’d give a quick try to see if I could release the adhesions without the use of an anesthetic. “OK, Mark” said I, “This may hurt for just a few seconds.” A quick maneuver and the adhesions were released. Mark looked down, looked up, and with wide-eyed wonderment exclaimed to his father: “Wow, Dad, Dr. Marshall did it with his bare hands! “