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Circumcision of neonates and children without appropriate anaesthesia is unacceptable practice
1Department of Anaesthesia, Flinders Medical Centre, Adelaide, South Australia. flyingdoc@bigpond.com
Insights
Neonatal circumcision is a painful procedure requiring adequate anesthesia. Current evidence suggests general anesthesia is most reliable, though topical anesthesia is insufficient for pain management.
Area of Science:
- Medical Ethics
- Pediatric Surgery
- Anesthesiology
Background:
- Neonatal circumcision is recognized as a painful surgical procedure.
- Policies by the Royal Australasian College of Physicians and Australian State Health Departments mandate appropriate anesthesia and analgesia.
- Anecdotal evidence suggests inadequate or absent anesthesia during neonatal circumcisions in Australia.
Purpose of the Study:
- To present evidence on the pain associated with neonatal circumcision.
- To review available anesthetic techniques for neonatal circumcision.
- To evaluate the adequacy of different anesthesia methods.
Main Methods:
- Review of existing medical literature and evidence regarding pain in neonatal circumcision.
- Analysis of current anesthetic techniques, including topical, local, regional, and general anesthesia.
- Consideration of policy guidelines from relevant medical bodies.
Main Results:
- Neonatal circumcision is demonstrably painful, necessitating effective pain management.
- Topical anesthesia (lignocaine-prilocaine cream) is insufficient for adequate pain control.
- General anesthesia is considered the most reliable method for ensuring pain relief.
- Local or regional anesthesia requires a dedicated, skilled anesthetist separate from the proceduralist.
Conclusions:
- Adequate anesthesia is crucial for neonatal circumcision due to its painful nature.
- General anesthesia offers the most reliable pain management, potentially necessitating delayed circumcision.
- Specialized anesthetic support is vital for local or regional techniques to be effective and safe.
Abstract:
Circumcision is painful surgery and appropriate intraoperative anaesthesia and postoperative analgesia is required. This is recognised in the policies of the Royal Australasian College of Physicians and the majority of Australian State Health Departments. Nevertheless, anecdotal evidence exists that neonatal circumcision continues to be performed in Australia with either no anaesthesia or with inadequate anaesthesia. This paper presents the evidence that neonatal circumcision is painful and reviews the available anaesthetic techniques. The authors conclude that general anaesthesia is arguably the most reliable way of ensuring adequate anaesthesia, although this may mean deferment of the procedure until the child is older. Local or regional anaesthesia for neonatal circumcision ideally requires a separate skilled anaesthetist (other than the proceduralist) to monitor the patient and intervene if the anaesthesia is inadequate. Topical anaesthesia with lignocaine-prilocaine cream is insufficient.
