Anesthesia for neonatal circumcision: local anesthesia is better than dorsal penile nerve block

Several studies document the benefit of dorsal penile nerve block for neonatal circumcision, but the literature does not address the use of local anesthesia. A randomized, controlled, prospective study was conducted to compare the efficacy of dorsal penile nerve block versus local anesthesia. Thirty infants were randomly divided into three equal groups (N = 10): an unanesthetized control group, a group given dorsal penile nerve block, and a group given local anesthesia. Heart rate, transcutaneous oxygen saturation, and crying were monitored continuously before, during, and after circumcision. During circumcision, both the dorsal penile nerve block group and the local-anesthesia group demonstrated smaller increases in heart rate, smaller drops in oxygen saturation, and less crying compared with unanesthetized controls (P less than .05). Both techniques worked well in anesthetizing the dorsal aspect of the penis; however, during those steps of circumcision involving trauma to the ventral aspect of the penis, the local-anesthesia group demonstrated smaller increases in heart rate and less crying compared with infants given dorsal penile nerve block (P less than .05). Cortisol levels measured 30 minutes postoperatively were lower in the local-anesthesia group than in either the controls or the dorsal penile nerve block group (P less than .05). Dorsal penile nerve block had no effect on postoperative cortisol levels. No complications occurred. Although both types of anesthesia attenuated the physiologic responses to circumcision, local anesthesia demonstrated greater efficacy than dorsal penile nerve block while being simpler to perform.