Avoidance of general anesthesia for circumcision in infants under 6 months of age using a modified Plastibell technique

Nguyên, Thành Tâm; Kraft, Elizabeth; Nasrawi, Ziyad; Joshi, Minal; Merianos, Demetri J.

doi:10.1007/s00383-019-04452-x

Cited by 10 publications

(10 citation statements)

References 18 publications

(5 reference statements)

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“…The success has been validated in numerous studies [2,4,6,8]. In most of the studies, the choice of anaesthetic/analgesic has been penile nerve block [9][10][11][12][13], although no gold standard procedure to address the pain in circumcision has been established [14]. In our study, the choice of anaesthetic was 2% Lignocaine with 1 ml solution infiltrated as a penile ring block.…”

Section: Discussionmentioning

confidence: 88%

Circumcision With the Plastibell Technique: A Descriptive Case Series

Ahmed¹,

Jan²,

Yasin³

et al. 2022

Cureus

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BackgroundThe Plastibell technique is one of the most commonly performed procedures used for male circumcision (MC) and is in practice throughout the world. It is a procedure done under local anaesthesia, mostly on infants. The results of the technique have been evaluated in many studies throughout the world. We have done a series of cases and present the results of our retrospective descriptive study. The objective of this study was to describe the outcomes of circumcision performed via the Plastibell technique. Materials and methodsThis retrospective descriptive study was conducted at the Surgical A Unit, Khyber Teaching Hospital, Peshawar from July 2013 to June 2021. Clinical records of the infants who underwent circumcision were collected. Infants under the age of six months brought by their parents were included in the study. Infants whose parents requested methods other than Plastibell and infants with bleeding disorders or a family history of such disorders were excluded from the study. The indication for circumcision was for religious reasons in all cases. Post-operative complications were noted in all cases. ResultsA total of 364 male babies under the age of six months (mean age 43.5±15 days) underwent circumcision with the Plastibell technique. The mean operative time was 11.3±3.7 minutes. The time it took for the ring to fall off was 7.8±3.04 days. In one case, primary haemorrhage required exploration and diathermy of the bleeder. Oedema occurred in 76(20.8%) of the babies. Adhesions of the foreskin with the glans were formed in 3(0.82%) cases. ConclusionMale circumcision is one of the oldest surgical procedures performed. Several methods are in practise in this regard. The results of our study showed that circumcision with the Plastibell method is safe and has fewer side effects.

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Section: Discussionmentioning

confidence: 88%

Circumcision With the Plastibell Technique: A Descriptive Case Series

Ahmed¹,

Jan²,

Yasin³

et al. 2022

Cureus

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“…The value of combining non-pharmacological analgesic methods with DPNB has been demonstrated not only in newborns but also in older infants [12]. Similarly, by adding sucrose to other analgesic methods, either EMLA, DPRB, or RB, the result was a minimal pain level during MC [30][31][32].…”

Section: Discussionmentioning

confidence: 99%

“…For the risk of neurological damage secondary to the use of general anesthetics, general anesthesia for MC in newborns should be avoided [11]. The use of local anesthesia for MC has proven to be a safe and effective way to prevent procedural pain both in neonates and in older children [5,[12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Management of pain in newborn circumcision: a systematic review

2020

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Male circumcision (MC) is one of the most common surgical procedures performed on neonates. In the last decades, there have been consistent advances in the understanding of pain mechanisms in newborns, and analgesia has become a fundamental part of neonatal care. MC is still often performed with inappropriate analgesic methods, and there is still great variability among the various centers about surgical and anesthethic techniques to do it. The purpose of this review is to summarize the findings in the literature about pain management and analgesia during newborn MC. We performed a systematic review of neonatal MC studies published in the last 20 years. The most effective technique appeared to be the combination of pharmacological and non-pharmacological methods of analgesia.Conclusion: Combining local anesthesia with non-pharmacological analgesic strategies appears to be effective preventing procedural pain during MC. However, a standardized protocol for analgesia during MC is yet to be determined. Sensorial saturation appeared to help when used in conjunction with the local anesthesia techniques. What is Known:• Male circumcision is a painful procedure and it is frequently performed with inappropriate analgesic methods.• A gold standard practice in analgesia during male circumcision is still lacking and there is a great variability in the modus operandi between centers. What is New:• The combination of RB + EMLA + sucrose appears to be an analgesic strategy superior to other approaches.• We advocate for the integration of sensorial saturation during male circumcision in order to improve the efficacy of current analgesic practices.

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“…This resulted in lower pain scores in the first postoperative hour and a longer interval should rescue analgesia be required. When the infant is younger than 6 months, general anaesthesia for MC should be avoided [ 238 ]. General anaesthesia has inherent risks, albiet low.…”

Section: Anaesthesiamentioning

confidence: 99%

Evidence-based circumcision policy for Australia

Morris¹,

Katelaris²,

Blumenthal³

et al. 2022

JOMH

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The aim was (1) to perform an up-to-date systematic review of the male circumcision (MC) literature and (2) to determine the number of adverse medical conditions prevented by early MC in Australia. Searches of PubMed using “circumcision” with 39 keywords and bibliography searches yielded 278 publications meeting our inclusion criteria. Early MC provides immediate and lifetime benefits, including protection against: urinary tract infections, phimosis, inflammatory skin conditions, inferior penile hygiene, candidiasis, various STIs, and penile and prostate cancer. In female partners MC reduces risk of STIs and cervical cancer. A risk-benefit analysis found benefits exceeded procedural risks, which are predominantly minor, by approximately 200 to 1. It was estimated that more than 1 in 2 uncircumcised males will experience an adverse foreskin-related medical condition over their lifetime. An increase in early MC in Australia to mid-1950s prevalence of 85% from the current level of 18.75% would avoid 77,000 cases of infections and other adverse medical conditions over the lifetime for each annual birth cohort. Survey data, physiological measurements, and the anatomical location of penile sensory receptors responsible for sexual sensation indicate that MC has no detrimental effect on sexual function, sensitivity or pleasure. US studies found that early infant MC is cost saving. Evidence-based reviews by the AAP and CDC support early MC as a desirable public health measure. Although MC can be performed at any age, early MC maximizes benefits and minimises procedural risks. Parents should routinely be provided with accurate, up-to-date evidence-based information in an unbiased manner early in a pregnancy so that they have time to weigh benefits and risks of early MC and make an informed decision should they have a son. Parental choice should be respected. A well-trained competent practitioner is essential and local anaesthesia should be routinely used. Third party coverage of costs is advocated.

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Avoidance of general anesthesia for circumcision in infants under 6 months of age using a modified Plastibell technique

Cited by 10 publications

References 18 publications

Circumcision With the Plastibell Technique: A Descriptive Case Series

Circumcision With the Plastibell Technique: A Descriptive Case Series

Management of pain in newborn circumcision: a systematic review

Evidence-based circumcision policy for Australia

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