A Comparison of the Mogen and Gomco Clamps in Combination With Dorsal Penile Nerve Block in Minimizing the Pain of Neonatal Circumcision

Kurtis, Peter S.; Desilva, Hema N.; Bernstein, Bruce; Malakh, Lillian; Schechter, Neil L.

doi:10.1542/peds.103.2.e23

Cited by 41 publications

(29 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[139][140][141][142][143][144][145] Therefore, adequate analgesia should be provided when newborn circumcision is performed. Topical 4% lidocaine, DPNB, and a subcutaneous ring block are all effective options, although the latter may provide the most effective analgesia.…”

Section: Nonpharmacologic Techniquesmentioning

confidence: 99%

Male Circumcision

Blank¹,

Brady²,

Buerk³

et al. 2012

Pediatrics

298

149

View full text Add to dashboard Cite

Male circumcision consists of the surgical removal of some, or all, of the foreskin (or prepuce) from the penis. It is one of the most common procedures in the world. In the United States, the procedure is commonly performed during the newborn period. In 2007, the American Academy of Pediatrics (AAP) convened a multidisciplinary workgroup of AAP members and other stakeholders to evaluate the evidence regarding male circumcision and update the AAP’s 1999 recommendations in this area. The Task Force included AAP representatives from specialty areas as well as members of the AAP Board of Directors and liaisons representing the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the Centers for Disease Control and Prevention. The Task Force members identified selected topics relevant to male circumcision and conducted a critical review of peer-reviewed literature by using the American Heart Association’s template for evidence evaluation. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks; furthermore, the benefits of newborn male circumcision justify access to this procedure for families who choose it. Specific benefits from male circumcision were identified for the prevention of urinary tract infections, acquisition of HIV, transmission of some sexually transmitted infections, and penile cancer. Male circumcision does not appear to adversely affect penile sexual function/sensitivity or sexual satisfaction. It is imperative that those providing circumcision are adequately trained and that both sterile techniques and effective pain management are used. Significant acute complications are rare. In general, untrained providers who perform circumcisions have more complications than well-trained providers who perform the procedure, regardless of whether the former are physicians, nurses, or traditional religious providers. Parents are entitled to factually correct, nonbiased information about circumcision and should receive this information from clinicians before conception or early in pregnancy, which is when parents typically make circumcision decisions. Parents should determine what is in the best interest of their child. Physicians who counsel families about this decision should provide assistance by explaining the potential benefits and risks and ensuring that parents understand that circumcision is an elective procedure. The Task Force strongly recommends the creation, revision, and enhancement of educational materials to assist parents of male infants with the care of circumcised and uncircumcised penises. The Task Force also strongly recommends the development of educational materials for providers to enhance practitioners’ competency in discussing circumcision’s benefits and risks with parents. The Task Force made the following recommendations:Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks, and the benefits of newborn male circumcision justify access to this procedure for those families who choose it.Parents are entitled to factually correct, nonbiased information about circumcision that should be provided before conception and early in pregnancy, when parents are most likely to be weighing the option of circumcision of a male child.Physicians counseling families about elective male circumcision should assist parents by explaining, in a nonbiased manner, the potential benefits and risks and by ensuring that they understand the elective nature of the procedure.Parents should weigh the health benefits and risks in light of their own religious, cultural, and personal preferences, as the medical benefits alone may not outweigh these other considerations for individual families.Parents of newborn boys should be instructed in the care of the penis, regardless of whether the newborn has been circumcised or not.Elective circumcision should be performed only if the infant’s condition is stable and healthy.Male circumcision should be performed by trained and competent practitioners, by using sterile techniques and effective pain management.Analgesia is safe and effective in reducing the procedural pain associated with newborn circumcision; thus, adequate analgesia should be provided whenever newborn circumcision is performed.Nonpharmacologic techniques (eg, positioning, sucrose pacifiers) alone are insufficient to prevent procedural and postprocedural pain and are not recommended as the sole method of analgesia. They should be used only as analgesic adjuncts to improve infant comfort during circumcision.If used, topical creams may cause a higher incidence of skin irritation in low birth weight infants, compared with infants of normal weight; penile nerve block techniques should therefore be chosen for this group of newborns.Key professional organizations (AAP, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American Society of Anesthesiologists, the American College of Nurse Midwives, and other midlevel clinicians such as nurse practitioners) should work collaboratively to:Develop standards of trainee proficiency in the performance of anesthetic and procedure techniques, including suturing;Teach the procedure and analgesic techniques during postgraduate training programs;Develop educational materials for clinicians to enhance their own competency in discussing the benefits and risks of circumcision with parents;Offer educational materials to assist parents of male infants with the care of both circumcised and uncircumcised penises.The preventive and public health benefits associated with newborn male circumcision warrant third-party reimbursement of the procedure. The American College of Obstetricians and Gynecologists has endorsed this technical report.

show abstract

Section: Nonpharmacologic Techniquesmentioning

confidence: 99%

Male Circumcision

Blank¹,

Brady²,

Buerk³

et al. 2012

Pediatrics

298

149

View full text Add to dashboard Cite

show abstract

“…13 In this study, we measured duration and intensity of pain with a simple behavioral scale after randomizing infants to one of two techniques -Mogen or PlastiBell. Our presumption was that the procedure of shortest duration would be the least painful granted the amount of pain per unit time was similar with each technique.…”

Section: Introductionmentioning

confidence: 99%

“…Our presumption was that the procedure of shortest duration would be the least painful granted the amount of pain per unit time was similar with each technique. Although circumcision is usually a rapid procedure in the hands of skilled operators, 13 no studies have compared the amount of time required by trainees to perform different techniques.…”

Section: Introductionmentioning

confidence: 99%

Pain During Mogen or PlastiBell Circumcision

et al. 2002

View full text Add to dashboard Cite

“…The various devices serve to protect the penis when excising the prepuce. The type of clamp used affects the time taken for the procedure, being on average 81 seconds for the Mogen clamp and 209 seconds for the Gomco clamp (Kurtis et al, 1999). In a head-to-head trial of length of procedure the Mogen took 12 minutes, compared with 20 minutes for the Plastibell (Taeusch et al, 2002).…”

Section: Medical Circumcision Of Infants and Very Young Boysmentioning

confidence: 99%

“…The latter time is far greater than others generally achieve (see 8.2.4 below). Although simpler to use and more pain-free than the other two (Kurtis et al, 1999;Kaufman et al, 2002;Taeusch et al, 2002), the Mogen clamp removes less foreskin. The Gomco is the oldest and is the most refined instrument (Wan, 2002).…”

Section: Medical Circumcision Of Infants and Very Young Boysmentioning

confidence: 99%