A pictorial and video guide to circumcision without pain

3 Despite the 1999 American Academy of Pediatrics (AAP) policy statement indicating that routine neonatal circumcision is not medically necessary, circumcision continues to be the most frequently performed surgical procedure in the newborn period in the United States. Further, many health care practitioners routinely perform this procedure without the use of any or with inadequate or ineffective analgesia and anesthesia. Multiple studies have evaluated the safety and efficacy of specific pharmacologic and nonpharmacologic interventions to relieve circumcision pain and discomfort. Penile nerve blocks, local anesthetics, various operative instruments, acetaminophen, sweet oral solutions, pacifiers, a physiologic restraining device, intrauterine sounds, and music all have been evaluated. This article synthesizes these studies and highlights their significance for current clinical practice. The article provides a detailed pictorial and video guide to circumcision with an emphasis on the use of multimodal strategies to ensure adequate anesthesia, analgesia, and infant comfort before, during, and after the procedure.