Local Anesthesia for Neonatal Circumcision

Stang, Howard J.; Gunnar, Megan R.; Snellman, Leonard W.; Condon, Lawrence M.; Kestenbaum, Roberta

doi:10.1001/jama.1988.03720100025033

Cited by 100 publications

(10 citation statements)

References 21 publications

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“…It should be noted as well that other studies using the Gomco clamp report a procedure time ranging from 5 to 15 minutes. 27 Our data reconfirm that DPNB is an extremely effective method of reducing pain during circumcision. This is most clearly demonstrated by the dramatic decrease in crying time when DPNB is used.…”

Section: Discussionsupporting

confidence: 73%

“…In previously reported studies of DPNB, a 27-gauge needle was used for the injection, including the study by Kirya and Werthmann. 13,27 Concerns have been raised regarding the safety of the DPNB, suggesting the need for further evaluation before encouraging its widespread use. 26,29 We looked for complications of the DPNB at the 2-week well-child visit.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 1999

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ABSTRACT. Objectives. 1) To compare the Mogen and Gomco clamps with regard to pain experienced during neonatal circumcision, and 2) to assess neonatal circumcision pain with and without dorsal penile nerve block (DPNB).Design/Methods. A randomized, controlled, nonblinded clinical trial; 48 healthy, full-term infants were randomized into one of the following four groups: Gomco vs Mogen with (؉) or without (؊) DPNB. DPNB؉ infants were injected with 0.8 mL of 1% lidocaine before circumcision. DPNB؊ infants received no placebo injection. Heart rate, respiratory rate, and oxygen saturation (SaO 2 ) during the procedure were monitored and data transferred to computer files by using the Datalab software system. Crying was recorded on videotape. Pre-and postcircumcision saliva samples for cortisol analysis were collected. Heart rate, respiratory rate, SaO 2 , cortisol changes, and duration of crying were evaluated statistically with two-way analyses of variance and t tests.Results ABBREVIATIONS. HR, heart rate; RR, respiratory rate; Sao 2 , oxygen saturation; DPNB, dorsal penile nerve block; ANOVA, analysis of variance.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

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

et al. 1999

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“…[19] Few minor complications like bleeding, hematoma and minor bruising have been reported. [20] There was no such complication in our study. A slow rate of injection taking 100-120 seconds avoided causing pain to the children while giving the block which is also supported by studies of Serour et al .…”

Section: Discussionmentioning

confidence: 46%

Penile block for paediatric urological surgery: A comparative evaluation with general anaesthesia

Panda¹,

Bajwa²,

Sen³

et al. 2011

Indian J Urol

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Aim:Peri-operative pain relief in children can be provided by conventional general anaesthesia or by regional nerve blocks. The present study was carried out to evaluate and compare the effectiveness of penile block for penile surgery with the standard technique of general anaesthesia (GA) of short duration of less than two hours, and also to evaluate the postoperative pain relief obtained by penile block.Materials and Methods:The study was carried out in the department of Anaesthesiology and Intensive care of our hospital, on 60 children in the age group of 1-10 years, belonging to American Society of Anesthesiologists (ASA) grades I and II, and divided randomly into two groups: Group B and group G, comprising of 30 patients each. Group B children received a penile block whereas group G children underwent a standard general anaesthetic procedure. Baseline, intra-operative and post-operative heart rate (HR), electrocardiogram (ECG), non-invasive blood pressure (NIBP) (systolic and diastolic) and pulse oximeter oxygen saturation (SpO2) were recorded at regular intervals. The duration of post-operative pain relief, time to rescue analgesia and time to first feed were also evaluated and recorded. Statistical analysis was carried out using statistical package for social sciences (SPSS) 11 version for windows and employing analysis of variance (ANOVA), unpaired student t test, Chi-square test and Mann Whitney U test for various parameters. Value of P<0.05 was considered as significant and P<0.0001 as highly significant.Results:The demographic characteristics were comparable in both the groups. Heart rate, systolic blood pressure, diastolic blood pressure and pulse oximetry showed remarkable differences at various time intervals during intra-operative and post-operative period, which were statistically significant on comparison (P<0.05 and P<0.0001). Post-operative pain relief, time to first rescue analgesia and time to first feed also showed statistically significant differences.Conclusions:Penile block is very effective when used along with light sedation for distal penile surgeries of less than 2 hours duration as compared to standard GA as reflected by more stable haemodynamics in peri-operative period, excellent pain relief extending up to 6-8 hrs postoperatively and absence of any significant complications or side effects.

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“…Nevertheless, it may be possible to evaluate the clinical significance of these findings by comparison to data on dampening of the cortisol response using sucrose following inoculations [36] or lidocaine prior to circumcision [48], both of which result in an approximately 30% reduction in cortisol relative to baseline or control, respectively. Note however that there are few studies and not all have observed significant effects, and while sucrose is now recommended for infant inoculations [46], the most convincing evidence comes from behavioural rather than physiologic data.…”

Section: Discussionmentioning

confidence: 99%

Prenatal bisphenol a exposure and dysregulation of infant hypothalamic-pituitary-adrenal axis function: findings from the APrON cohort study

et al. 2017

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BackgroundAnimal models show that prenatal bisphenol A (BPA) exposure leads to sexually dimorphic disruption of the neuroendocrine system in offspring, including the hypothalamic-pituitary-adrenal (HPA) neuroendocrine system, but human data are lacking. In humans, prenatal BPA exposure is associated with sex-specific behavioural problems in children, and HPA axis dysregulation may be a biological mechanism. The objective of the current study was to examine sex differences in associations between prenatal maternal urinary BPA concentration and HPA axis function in 3 month old infants.MethodsMother-infant pairs (n = 132) were part of the Alberta Pregnancy Outcomes and Nutrition study, a longitudinal birth cohort recruited (2010–2012) during pregnancy. Maternal spot urine samples collected during the 2nd trimester were analyzed for total BPA and creatinine. Infant saliva samples collected prior to and after a blood draw were analyzed for cortisol. Linear growth curve models were used to characterize changes in infant cortisol as a function of prenatal BPA exposure.ResultsHigher maternal BPA was associated with increases in baseline cortisol among females (β = 0.13 log μg/dL; 95% CI: 0.01, 0.26), but decreases among males (β = −0.22 log μg/dL; 95% CI: -0.39, −0.05). In contrast, higher BPA was associated with increased reactivity in males (β = .30 log μg/dL; 95% CI: 0.04, 0.56) but decreased reactivity in females (β = −0.15 log μg/dL; 95% CI: -0.35, 0.05). Models adjusting for creatinine yielded similar results.ConclusionsPrenatal BPA exposure is associated with sex-specific changes in infant HPA axis function. The biological plausibility of these findings is supported by their consistency with evidence in rodent models. Furthermore, these data support the hypotheses that sexually dimorphic changes in children’s behaviour following prenatal BPA exposure are mediated by sexually dimorphic changes in HPA axis function.

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Local Anesthesia for Neonatal Circumcision

Cited by 100 publications

References 21 publications

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

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

Penile block for paediatric urological surgery: A comparative evaluation with general anaesthesia

Prenatal bisphenol a exposure and dysregulation of infant hypothalamic-pituitary-adrenal axis function: findings from the APrON cohort study

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