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The Pediatric Forum |

Neonatal Circumcision

Robert S. Van Howe, MD; Christopher J. Cold, MD
Arch Pediatr Adolesc Med. 1998;152(9):931. doi:.
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Is the report published by Herschel et al1 regarding the use of a sucrose pacifier for pain control an attempt to attenuate the collective guilt we as a profession have for introducing and perpetuating routine male genital alteration in the United States? While the optimistic spin on the published results is that a sucrose pacifier or a dorsal penile nerve block reduces the heart rate increases associated with neonatal circumcision, a more realistic take is that notable increases in heart rate are not avoided with either modality. All published studies of topical and local anesthetic use for neonatal circumcision have documented notable increases in the pain parameters. This suggests that these modalities, although better than no anesthetic, do not provide complete anesthesia. Although neonates have a lower pain threshold,2 these modalities are considered inadequate for the same procedure in older children and adults.3 Do we employ anesthetics that are inadequate on neonates because of the cost savings or because we can get away with it?4

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