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March 11, 1988, Vol 259, No. 10 >
ARTICLE | March 11, 1988

Local Anesthesia for Neonatal Circumcision: Title and subTitle BreakEffects on Distress and Cortisol Response FREE

Howard J. Stang, MD; Megan R. Gunnar, PhD; Leonard Snellman, MD; Lawrence M. Condon, MD; Roberta Kestenbaum
[+] Author Affiliations

Reprint requests to Group Health Inc, 1430 Hwy 96, White Bear Lake, MN 55110 (Dr Stang).


JAMA. 1988;259(10):1507-1511. doi:10.1001/jama.1988.03720100025033
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References

A controlled, double-blind investigation was conducted to determine whether the dorsal penile nerve block using lidocaine hydrochloride without epinephrine would effectively reduce behavioral distress and adrenocortical responses to routine neonatal circumcision. The subjects were healthy male newborns whose parents had requested circumcision. Equal numbers (n=20) were randomly assigned to circumcision with lidocaine, saline, or no injection. Dorsal penile nerve block was found to be a safe and easy technique that was effective in reducing behavioral distress and modifying the adrenocortical stress response. The injection itself did not increase stress reactions and did not offset the beneficial effects of anesthesia. If circumcisions are to be performed, they should be done as humanely as possible.

(JAMA 1988;259:1507-1511)

REFERENCES

1 +
Grimes DA:  Routine circumcision of the newborn infant: A reappraisal. Am J Obstet Gynecol 1978;;130:125-129.
2 +
American Academy of Pediatrics Committee on Fetus and Newborn:  Report of the ad hoc task force on circumcision. Pediatrics 1975;;56:610.
3 +
Grossman E, Posner NA:  Surgical circumcision of newborns: A history of its development. Obstet Gynecol 1981;;58:241-245.
4 +
Herrera AJ, Hsu AS, Salcedo UT, et al:  The role of parental information on the incidence of circumcision. Pediatrics 1982;;70:597-598.
5 +
Maisels MJ, Hays B, Conrad S, et al:  Circumcision: The effect of information on parental decision making. Pediatrics 1983;;71:453-455.
6 +
Lunn JN:  Postoperative analgesia after circumcision: A randomized comparison between caudal analgesia and intramuscular morphine in boys. Anaesthesia 1979;;34:552-554.
7 +
Bacon AK:  An alternative block for post circumcision analgesia. Anaesth Intensive Care 1977;;5:63-64.
8 +
Yeoman PM, Cooke R, Hain WR:  Penile block for circumcision? Anaesthesia 1983;;38:862-866.
9 +
Lau JTK:  Penile block for pain relief after circumcision in children. Am J Surg 1984;;147:797-799.
10 +
Speert H:  Circumcision of the newborn. Obstet Gynecol 1953;;2:164-172.
11 +
Katz J:  The question of circumcision. Int Surg 1977;;62:490-492.
12 +
Izard CE, HembreeEA, Huebner RR:  Infants' emotion expressions to acute pain: Developmental change and stability of individual differences. Dev Psychol 1987;;23:105-113.
13 +
Gunnar MR, Fisch RO, Korsvik S, et al:  The effects of circumcision on serum cortisol and behavior. Psychoneuroendocrinology 1981;;6:269-275.
14 +
Anand KJS, Hickey PR:  Pain and its effects in the human neonate and fetus. N Engl J Med 1987;;317:1321-1329.
15 +
Kirya C, Werthmann MW:  Neonatal circumcision and penile dorsal nerve block: A painless procedure. J Pediatr 1978;;96:998-1000.
16 +
Holve R, Bromberger P, Weinstein H, et al:  Regional anesthesia during newborn circumcision. Clin Pediatr 1984;;22:813-818.
17 +
Pelosi MA, Apuzzio J:  Making circumcision a painless event. Contemp Pediatr , (January) 1985;, pp 85-88.
18 +
Williamson PS, Williamson ML:  Physiologic stress reduction by a local anesthetic during newborn circumcision. Pediatrics 1983;;71:36-40.
19 +
Dixon S, Snyder J, Holve R, et al:  Behavioral effects of circumcision with and without anesthesia. J Dev Behav Pediatr 1984;;5:246-250.
20 +
Ferguson KJ, Caplan RM, Williamson PS:  Factors associated with behavior change in family physicians after CME presentation. J Med Educ 1984;;59:662-666.
21 +
Talbert LM, Kraybill EN, Potter HD:  Adrenal cortical response to circumcision in the neonate. Obstet Gynecol 1976;;48:208-210.
22 +
Gunnar MR, Malone S, Vance G, et al:  Quiet sleep and levels of plasma cortisol during recovery from circumcision in newborns. Child Dev 1985;;56:824-834.
23 +
Gunnar M:  Human developmental psychoneuroendocrinology: A review of research on neuroendocrine responses to challenge and threat in infancy and childhood , in Lamb M, Brown A, Rogoff B (eds): Advances in Developmental Psychology . Hillsdale, NJ, Lawrence Erlbaum Associates Inc Publishers, 1986;, vol 4, pp 51-103.
24 +
Brazelton TB:  Neonatal behavioral assessment scale. Clin Dev Med 1973;;50:1-66.
25 +
Gunnar M, Fisch R, Malone S:  The effects of pacifying stimulus on behavioral and adrenocortical responses to circumcision. J Am Acad Child Adolesc Psychiatry 1984;;23:34-38.
26 +
Vernikos-Danellis J, Heybach J:  Psychophysiologic mechanisms regulating the hypothalamic-pituitary-adrenal response to stress , in Seyle H (ed): Seyle's Guide to Stress Research . New York, Van Nostrand Reinhold Co, 1980;, vol 1, pp 206-251.
27 +
Rawlings DJ, Miller PA, Engle RR:  The effect of circumcision on transcutaneous Po2 in term infants. AJDC 1980;;134:676-678.
28 +
Emde RN, Harmon RJ, Metcalf D, et al:  Stress and neonatal sleep. Psychosom Med 1971;;33:491-497.
29 +
Marshall RE, Stratton WC, Moore JA, et al:  Circumcision: I. Effects on newborn behavior. Infant Behav Dev 1980;;3:1-14.
30 +
Sara CA, Lowry CJ:  A complication of circumcision and dorsal nerve block of the penis. Anaesth Intensive Care 1984;;13:79-85.
31 +
Williamson PS, Evans ND:  Neonatal cortisol response to circumcision with anesthesia. Clin Pediatr 1986;;25:412-425.
32 +
American Academy of Pediatrics Committee on Fetus and Newborn and Committee on Drugs:  Neonatal anesthesia. Pediatrics 1987;;80:446.
33 +
Guide for the Care and Use of Laboratory Animals , publication (NIH) 8523. US Dept of Health and Human Services, 1985;.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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1 +
Grimes DA:  Routine circumcision of the newborn infant: A reappraisal. Am J Obstet Gynecol 1978;;130:125-129.
2 +
American Academy of Pediatrics Committee on Fetus and Newborn:  Report of the ad hoc task force on circumcision. Pediatrics 1975;;56:610.
3 +
Grossman E, Posner NA:  Surgical circumcision of newborns: A history of its development. Obstet Gynecol 1981;;58:241-245.
4 +
Herrera AJ, Hsu AS, Salcedo UT, et al:  The role of parental information on the incidence of circumcision. Pediatrics 1982;;70:597-598.
5 +
Maisels MJ, Hays B, Conrad S, et al:  Circumcision: The effect of information on parental decision making. Pediatrics 1983;;71:453-455.
6 +
Lunn JN:  Postoperative analgesia after circumcision: A randomized comparison between caudal analgesia and intramuscular morphine in boys. Anaesthesia 1979;;34:552-554.
7 +
Bacon AK:  An alternative block for post circumcision analgesia. Anaesth Intensive Care 1977;;5:63-64.
8 +
Yeoman PM, Cooke R, Hain WR:  Penile block for circumcision? Anaesthesia 1983;;38:862-866.
9 +
Lau JTK:  Penile block for pain relief after circumcision in children. Am J Surg 1984;;147:797-799.
10 +
Speert H:  Circumcision of the newborn. Obstet Gynecol 1953;;2:164-172.
11 +
Katz J:  The question of circumcision. Int Surg 1977;;62:490-492.
12 +
Izard CE, HembreeEA, Huebner RR:  Infants' emotion expressions to acute pain: Developmental change and stability of individual differences. Dev Psychol 1987;;23:105-113.
13 +
Gunnar MR, Fisch RO, Korsvik S, et al:  The effects of circumcision on serum cortisol and behavior. Psychoneuroendocrinology 1981;;6:269-275.
14 +
Anand KJS, Hickey PR:  Pain and its effects in the human neonate and fetus. N Engl J Med 1987;;317:1321-1329.
15 +
Kirya C, Werthmann MW:  Neonatal circumcision and penile dorsal nerve block: A painless procedure. J Pediatr 1978;;96:998-1000.
16 +
Holve R, Bromberger P, Weinstein H, et al:  Regional anesthesia during newborn circumcision. Clin Pediatr 1984;;22:813-818.
17 +
Pelosi MA, Apuzzio J:  Making circumcision a painless event. Contemp Pediatr , (January) 1985;, pp 85-88.
18 +
Williamson PS, Williamson ML:  Physiologic stress reduction by a local anesthetic during newborn circumcision. Pediatrics 1983;;71:36-40.
19 +
Dixon S, Snyder J, Holve R, et al:  Behavioral effects of circumcision with and without anesthesia. J Dev Behav Pediatr 1984;;5:246-250.
20 +
Ferguson KJ, Caplan RM, Williamson PS:  Factors associated with behavior change in family physicians after CME presentation. J Med Educ 1984;;59:662-666.
21 +
Talbert LM, Kraybill EN, Potter HD:  Adrenal cortical response to circumcision in the neonate. Obstet Gynecol 1976;;48:208-210.
22 +
Gunnar MR, Malone S, Vance G, et al:  Quiet sleep and levels of plasma cortisol during recovery from circumcision in newborns. Child Dev 1985;;56:824-834.
23 +
Gunnar M:  Human developmental psychoneuroendocrinology: A review of research on neuroendocrine responses to challenge and threat in infancy and childhood , in Lamb M, Brown A, Rogoff B (eds): Advances in Developmental Psychology . Hillsdale, NJ, Lawrence Erlbaum Associates Inc Publishers, 1986;, vol 4, pp 51-103.
24 +
Brazelton TB:  Neonatal behavioral assessment scale. Clin Dev Med 1973;;50:1-66.
25 +
Gunnar M, Fisch R, Malone S:  The effects of pacifying stimulus on behavioral and adrenocortical responses to circumcision. J Am Acad Child Adolesc Psychiatry 1984;;23:34-38.
26 +
Vernikos-Danellis J, Heybach J:  Psychophysiologic mechanisms regulating the hypothalamic-pituitary-adrenal response to stress , in Seyle H (ed): Seyle's Guide to Stress Research . New York, Van Nostrand Reinhold Co, 1980;, vol 1, pp 206-251.
27 +
Rawlings DJ, Miller PA, Engle RR:  The effect of circumcision on transcutaneous Po2 in term infants. AJDC 1980;;134:676-678.
28 +
Emde RN, Harmon RJ, Metcalf D, et al:  Stress and neonatal sleep. Psychosom Med 1971;;33:491-497.
29 +
Marshall RE, Stratton WC, Moore JA, et al:  Circumcision: I. Effects on newborn behavior. Infant Behav Dev 1980;;3:1-14.
30 +
Sara CA, Lowry CJ:  A complication of circumcision and dorsal nerve block of the penis. Anaesth Intensive Care 1984;;13:79-85.
31 +
Williamson PS, Evans ND:  Neonatal cortisol response to circumcision with anesthesia. Clin Pediatr 1986;;25:412-425.
32 +
American Academy of Pediatrics Committee on Fetus and Newborn and Committee on Drugs:  Neonatal anesthesia. Pediatrics 1987;;80:446.
33 +
Guide for the Care and Use of Laboratory Animals , publication (NIH) 8523. US Dept of Health and Human Services, 1985;.

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