title: Combined analgesia and local anesthesia to minimize pain during circumcision.
abstract: BACKGROUND
  Pain of circumcision is only partially relieved by single modalities, such as penile nerve block, lidocaine-prilocaine cream, and sucrose pacifiers.
  
  
  OBJECTIVE
  To assess the effectiveness of a combination of interventions on the pain response of infants undergoing circumcision.
  
  
  METHODS
  Cohort study. Group 1 included infants circumcised using the Mogen clamp and combined analgesics (lidocaine dorsal penile nerve block, lidocaine-prilocaine, acetaminophen, and sugar-coated gauze dipped in grape juice). Group 2 included infants circumcised using the Gomco clamp and lidocaine-prilocaine. Infants were videotaped during circumcision, and pain was assessed using facial activity scores and percentage of time spent crying.
  
  
  RESULTS
  There were 57 infants in group 1 and 29 infants in group 2. Birth characteristics did not differ between groups. Infants in group 1 were older than infants in group 2 (17 days vs 2 days) (P < .001). The mean duration of the procedure was 55 seconds and 577 seconds for infants in group 1 and 2, respectively (P < .001). Facial action scores and percentage of time spent crying were significantly lower during circumcision for infants in group 1 (P < .001). The percentage of time spent crying was 18% and 40% for infants in groups 1 and 2, respectively. No adverse effects were observed in infants in group 1; 1 infant in group 2 had a local skin infection.
  
  
  CONCLUSIONS
  Infants circumcised with the Mogen clamp and combined analgesia have substantially less pain than those circumcised with the Gomco clamp and lidocaine-prilocaine cream. Because of the immense pain during circumcision, combined local anesthesia and analgesia using the Mogen clamp should be considered.
authors.affiliation: Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada. anna.taddio@sickkids.on.ca
authors.forename: A
authors.initials: A
authors.lastname: Taddio
authors.forename: N
authors.initials: N
authors.lastname: Pollock
authors.forename: C
authors.initials: C
authors.lastname: Gilbert-MacLeod
authors.forename: K
authors.initials: K
authors.lastname: Ohlsson
authors.forename: G
authors.initials: G
authors.lastname: Koren
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage; D000698:Analgesia / Q000379:methods* / Q000706:statistics & numerical data; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage; D000704:Analysis of Variance; D000772:Anesthesia, Local / Q000379:methods* / Q000706:statistics & numerical data; D019162:Anesthetics, Combined / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D016009:Chi-Square Distribution; D002944:Circumcision, Male / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D015331:Cohort Studies; D006801:Humans; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000517:prevention & control*; D008012:Lidocaine / Q000008:administration & dosage; D000077442:Lidocaine, Prilocaine Drug Combination; D008297:Male; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement / Q000379:methods / Q000706:statistics & numerical data; D011318:Prilocaine / Q000008:administration & dosage
chemical_list: D018712:Analgesics, Non-Narcotic; D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D000077442:Lidocaine, Prilocaine Drug Combination; D011318:Prilocaine; D000082:Acetaminophen; D008012:Lidocaine