Study supports easing circumcision pain.

Study supports easing circumcision pain

Concern over possible side-effects has prevented physicians from reaching a consensus on the use of local anesthesia during circumcision, despite several studies showing that infants are in pain during the short procedure. In the most recent of these studies, Minnesota researchers concluded last week that local anesthesia should be used for circumcisions and that physicians can quickly learn the proper way to administer the drug involved. In addition to the standard observations of infant behavior, the study includes the more objective measurement of blood levels of pain-related hormones. The study is unlikely, however, to singlehandedly resolve questions about circumcision, which is performed more than 1 million times each year in the United States.

In a controlled, double-blind study, researchers at Group Health Inc. and the University of Minnesota in Minneapolis divided 60 newborns into three groups: Twenty received injections of lidocaine hydrochloride at the base of their penises before surgery, 20 received saline injections and 20 received no injections. The scientists then measured the percent of time the infants spent crying before, during and after surgery, as well as the blood levels of the stress-induced hormone cortisol.

They conclude in the March 11 Journal OF The American Medical Association that the so-called dorsal penile nerve block significantly reduced crying and cortisol levels without short-term side-effects. The penile block, although first introduced for circumcision in 1978, has not been embraced by physicians worried about adding yet another medical step to circumcision, where pain is short-lived. Included in the possible dangers of improper administration are tissue damage from reactions to the injection and life-threatening cardiovascular effects. But, says Group Health's Leonard Snellman, the latest study indicates "it's pretty clear that [the block] works, and that it's not dangerous." He said in an interview that, since completion of the reported study, physicians have performed several hundred similar procedures without problems. The authors assert that "if circumcisions are to be performed, they should be done as humanely as possible."

But other physicians are divided on whether anesthesia's benefits outweigh its threat as another source of complications. An anesthesia supporter, Frederic A. Berry of the University of Virginia in Charlottesville, told Science News that "it's not only a practical issue, but a philosophical one of minimizing the newborn's pain." He says new monitoring equipment eliminates the possibility that an anesthetic will dangerously affect the cardiovascular system.

According to Gerald Merenstein of the University of Colorado in Denver, pain during circumcision done by an experienced practitioner should last only a few minutes. However, he says he is "neutral" about the anesthesia issue: "There's no medication that's without risk, but if the circumcision is being done, there's no question the infant is feeling pain." Drug injections do carry the risk of tissue injury, says Merenstein, but he also notes that the longer 10- to 15-minute circumcision by an inexperienced doctor means prolonged pain for the infant.

The more basic issue, says Merenstein, is whether circumcision should be done for other than religious reasons. In 1971, the American Academy of Pediatrics (AAP) of Elk Grove Village, Ill., concluded that there is no medical indication for routine circumcision. Although an initial decline in circumcision followed, the percentage of U.S. male newborns circumcised has stabilized at about 60 percent. Yet there may be a reversal of official AAP opinion. Because of recent studies showing that circumcised males are at lower risk of becoming infected with sexually transmitted diseases than uncircumcised males, an AAP review board is reevaluating its position. Board members held their first in a series of meetings this week.