Behavioral Effects of Circumcision with and without Anesthesia

Dixon, Suzanne; Snyder, Joel M.; Holve, Richard L.; Bromberger, Patricia J.

doi:10.1097/00004703-198410000-00004

Cited by 100 publications

(42 citation statements)

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“…To exploit this potential, (1) findings from previous studies need to be assimilated and consolidated, (2) novel approaches for pain assessment must be investigated, (3) the importance of short-term and longterm clinical outcomes needs to be defined, (4) relevant outcomes and their surrogate markers need to be developed, 5 ethical and regulatory needs should be addressed, and (5) clinical trials using the currently available and newer pharmacologic agents must be designed, perhaps by using novel study designs. Additional studies in preterm neonates, for example, must devise ways to distinguish the effects of multiple factors that cause prematurity and differentiate the incident factors associated with immaturity from the effects of repetitive neonatal pain.…”

Section: Discussionmentioning

confidence: 99%

“…Since the early 1980s, it has become increasingly appreciated that the fetus and newborn perceive and respond to pain [1][2][3][4][5][6] (see Table 1 for definitions). Pain in the newborn is a complex, multilayered phenomenon involving different sources of pain and different types of pain, which can involve various combinations of receptors and mechanisms within the developing nervous system.…”

Section: Introductionmentioning

confidence: 99%

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Summary Proceedings From the Neonatal Pain-Control Group

et al. 2006

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Recent advances in neurobiology and clinical medicine have established that the fetus and newborn may experience acute, established, and chronic pain. They respond to such noxious stimuli by a series of complex biochemical, physiologic, and behavioral alterations. Studies have concluded that controlling pain experience is beneficial with respect to short-term and perhaps long-term outcomes. Yet, pain-control measures are adopted infrequently because of unresolved scientific issues and lack of appreciation for the need for control of pain and its long-term sequelae during the critical phases of neurologic maturation in the preterm and term newborn. The neonatal pain-control group, as part of the Newborn Drug Development Initiative (NDDI) Workshop I, addressed these concerns. The specific issues addressed were (1) management of pain associated with invasive procedures, (2) provision of sedation and analgesia during mechanical ventilation, and (3) mitigation of pain and stress responses during and after surgery in the newborn infant. The cross-cutting themes addressed within each category included (1) clinical-trial designs, (2) drug prioritization, (3) ethical constraints, (4) gaps in our knowledge, and (5) future research needs. This article provides a summary of the discussions and deliberations. Full-length articles on procedural pain, sedation and analgesia for ventilated infants, perioperative pain, and study designs for neonatal pain research were published in Clinical Therapeutics (June 2005).www.pediatrics.org/cgi

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Summary Proceedings From the Neonatal Pain-Control Group

et al. 2006

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“…21 Boys who have had anesthesia certainly are better at feeding, quieting themselves, and responding to stimuli than are their counterparts who were not given the benefit of pain relief. 32 "Not familiar with technique" was the reason given by 18% of the circumcisers. The DPNB technique has been described since 1978 in multiple papers.…”

Section: Discussionmentioning

confidence: 99%

Circumcision Practice Patterns in the United States

Stang

Snellman

1998

Pediatrics

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ABSTRACT. Objective. To determine 1) the performing of circumcision by medical specialty, gender, and years of practice; 2) the pattern of anesthetic use for this procedure; and 3) the reasons physicians cite for not using anesthesia.Design. A total of 3066 questionnaires were received from a mailing to a representative sampling of physicians stratified by specialty and geographic location.Results. Fifty-eight percent (1768) of the questionnaires were returned and interpretable from the following specialists: pediatricians (PEDs), 73% (n ‫؍‬ 691); family practitioners (FPs), 52% (n ‫؍‬ 464); and obstetricians (OBs), 51% (n ‫؍‬ 623).Of the respondents, 956 (54%) perform at least one circumcision per month (35% of PEDs; 60% of FPs; 70% of OBs). Of the physicians performing circumcisions, 45% use anesthesia (71% of PEDs; 56% of FPs; 25% of OBs). Of physicians using anesthesia, 85% use dorsal penile nerve block.A significantly higher percentage of male physicians (57%) are performing circumcisions than are females (45%), but there was no difference in the percent using anesthesia. Recently trained PEDs and FPs were more likely to use anesthetics than were their older colleagues, but OB use of pain relief was independent of their practice longevity. Physicians in the western states were significantly more likely to use anesthesia than were other physicians from the rest of the United States.Respondents who did not use anesthesia cited "concern over adverse drug effects" (54%) followed by "procedure does not warrant anesthesia" (44%) as the most common explanations.Conclusions. A substantial number of PEDs are performing circumcisions, and they are most likely to use anesthesia (71%), followed by FPs (56%), then OBs (25%). With recent recognition of the importance of pain reduction in neonatal procedures and the lack of substantiated contraindications to newborn anesthetic use, additional education of current practitioners, residents, and parents is required to increase the use of anesthesia for circumcision. Pediatrics 1998;101(6). URL: http://www. pediatrics.org/cgi/content/full/101/6/e5; circumcision, anesthesia for neonatal circumcision.ABBREVIATIONS. AAP, American Academy of Pediatrics; DPNB, dorsal penile nerve block; EMLA, eutectic mixture of local anesthetics; OB, obstetrician; FP, family practitioner; PED, pediatrician.

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“…Unanesthetized circumcision in the neonatal period was associated with changes in neonatal behavior for prolonged periods of time [63][64][65] and an increased behavioral responsiveness to the pain of vaccination at 4-5 months age [66][67][68]. Stressful conditions at birth were similarly associated with increased salivary cortisol responses to vaccination at 4 and 6 months of age [69].…”

Section: Potential Long-term Effects Of Neonatal Painmentioning

confidence: 99%

Clinical Importance of Pain and Stress in Preterm Neonates

1997

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Clinical and laboratory investigations of neonatal pain suggest that preterm neonates have an increased sensitivity to pain and that acute painful stimuli lead to the development of prolonged periods of hyperalgesia. Non-noxious stimuli during these periods of hyperalgesia may expose preterm neonates to established or chronic pain. Acute physiologic changes caused by painful or stressful stimuli can be implicated as important factors in the causation or subsequent extension of early intraventricular hemorrhage (IVH) or the ischemic changes leading to periventricular leukomalacia (PVL). Therapeutic interventions that provide comfort/analgesia in preterm neonates were correlated with a decreased incidence of severe IVH. Long-term follow-up studies of preterm neonates may substantiate the preliminary data associating repetitive painful experiences with some of the neurobehavioral and developmental sequelae resulting from neonatal intensive care.

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Behavioral Effects of Circumcision with and without Anesthesia

Cited by 100 publications

References 0 publications

Summary Proceedings From the Neonatal Pain-Control Group

Summary Proceedings From the Neonatal Pain-Control Group

Circumcision Practice Patterns in the United States

Clinical Importance of Pain and Stress in Preterm Neonates

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