Abstract
Male circumcision (MC) is one of the oldest and most common operations performed all over the world. It can be performed at different ages, using different surgical techniques, for different religious, cultural and medical reasons.Our aim is to examine and compare the various methods of analgesia and different surgical procedures reported in literature that are applied in infant MC. We performed a PubMed, MEDLINE, EMBASE and Cochrane search in the papers published since 2000: 14 studies met the inclusion criteria, most of them showing that a combined pharmacological and non-pharmacological intervention is the best analgesic option, in particular when the dorsal penile nerve block is combined with other treatments. The Mogen surgical procedure seems to be the less painful surgical intervention, when compared with Gomco clamp or PlastiBell device. Only 3 papers studied groups of at least 20 babies each with the use of validated pain scales. Data show a dramatic decrease of pain with dorsal penile nerve block, plus acetaminophen associated to oral sucrose or topic analgesic cream. However, no procedure has been found to definetively eliminate pain; the gold standard procedure to make MC totally painfree has not yet been established.
Highlights
The relief of human suffering is one of the most important goals for health care providers
Male circumcision (MC) is one of the most painful procedures a newborn can undergo, but only in the last few years caregivers have tried to fight this kind of pain; this might be due to the pain being in some ways, a component of the ritual that for centuries has accompanied MC
ring block (RB) causes a painful response in the majority of the babies, but this is mostly noted in babies over one week of age
Summary
The relief of human suffering is one of the most important goals for health care providers. Advances in neonatology have significantly improved neonatal morbidity and mortality; but pain, discomfort, and stress remain sad realities for babies in the neonatal intensive care unit [1]. Newborns’ pain can harm the developing brain in several ways, among which is the increase of free radical production [3]. Male circumcision (MC) is one of the most painful procedures a newborn can undergo, but only in the last few years caregivers have tried to fight this kind of pain; this might be due to the pain being in some ways, a component of the ritual that for centuries has accompanied MC. Even during clinical trials, babies still undergo MC without analgesia [4] and the continuous production of studies for a better analgesia is the sign that a gold standard has not yet been found
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