Behavioral effects of circumcision with and without anesthesia

The behavior of full-term neonates undergoing circumcision with and without local anesthesia was examined using the Brazelton Neonatal Assessment Scale (BNAS). Evaluations were done blindly pre-and postcircumcision and on the day following the procedure. Infants receiving lidocaine in a dorsal penile nerve block (DPNB) remained more attentive to animate and inanimate stimuli following circumcision and demonstrated a greater ability to quiet themselves when disturbed. The smoothness and maturity of motor behaviors showed the expected rate of improvement or recovery curve in the anesthetized group, while the control group's behavior did not. Behavioral differences were still evident on the day following the procedure. This report adds to the growing body of data that indicate that circumcision is a painful procedure that disrupts the course of behavioral recovery following birth. These disruptions can be lessened by the use of local anesthesia to relieve pain and stress during the procedure without any additional morbidity. These data support the use of DPNB during anesthesia for routine neonatal circumcisions still requested by the majority of parents in the country.