Anaesthetic use in circumcision evaluated

[baybee]

I guess docs are largely conceding that circumcision hurts a baby now because
84% of circs are done with anaesthetics. Those poor little guys that are the 16%. Baybee

http://www.ambulatorypediatrics.org/...01237/abstract

Conclusions

The percentage of training programs that teach effective analgesia for neonatal circumcision increased dramatically since the time of the previous data collection. Despite this improvement in teaching practices, some training programs may not consistently use effective analgesia for neonatal circumcision.

[pdx.mothernurture]

I would like to know how "effective analgesia" is defined. I'll bet EMLA, used alone, is included---which is hardly "effective" during the most invasive (deep tissue trauma) parts of the procedure. Another concern is this is looking at what new residents are being taught; it did not appear to reassess whether practicing, non-resident physicians have significantly changed their practices since the last survey.



Jen

[baybee]

Yes, I think you're right, Jen.

The thing about analgaesics is that they lead to problems ---swelling of the tissues, excessive bleeding and blood coagulation problems. Emla, as you know, is not recommended for babies under 6 mos of age and never for use on the genitals. Therefore it's a damned if you do and damned if you don't situation.
The bottom line is that boys need to keep their foreskins on their bodies---there's no sane humane way to take it off.
Baybee

[A&A]

Originally Posted by baybee

The bottom line is that boys need to keep their foreskins on their bodies---there's no sane humane way to take it off.
Baybee

And no reason to, anyway.

[jessjgh1]

I still thought EMLA wasn't safe for newborns. That issue is a little confusing, something on CIRP, I believe says that.

Jessica

[phatchristy]

Originally Posted by jessjgh1

I still thought EMLA wasn't safe for newborns. That issue is a little confusing, something on CIRP, I believe says that.

Jessica

A while back I read a story about a mom whose son went into cardiac arrest during a circumcision from what they believe was a reaction to the anesthetic (which I think was topical as well). Just horrific!

[enstar780]

A topical anesthetic is not really very effective against circumcision pain. This will not penetrate into the foreskin/glans junction, which are still adhered to and are ripped apart. It will not prevent pain on the inner surface of the foreskin, so extensive pain is still experienced, it hardly indeed makes a difference. An injected local, such as ring block is more significant, but there is still possibility of pain being experienced by the infant, including post operative pain. It may be that the only anesthetic capable of blocking severe pain is a general and proper post operative pain relief. Since the infant is not able to lingually express its pain and how effective the pain relief is, it is hard to say if what it is being given is effective. An adult can more adeqately advocate for their rights to pain relief and express their need for it, and how effective the relief is and if more is needed, they can express the need for pain relief and work to protect themselves and speak out for themselves to assure they get proper relief. General anesthetic is also safer for an adult than for an infant. This is why it is actually less potentially painful to do circumcision on an adult than on an infant.

Most people will not ever need circumcision so saying that it should be done to infants for prevention is a poor excuse to mutilate them. Prevention in any cases is an improper reason to surgically alter the body of any person without their consent.

a general can be given to an infant, but it requires great care to do so, and it should only be reserved for essential procedures, and truly only essential surgical procedures should be performed on infants. There is no need to perform unnecessary and improperly anesthetised surgical procedures on infants.

Even if circumcision could be made completely painless, it would still be wrong to do it, and the main ethical argument against circumcision still has not been addressed, that is, the human rights to a whole and complete body and to not have parts removed for non essential reasons to not necessary treat a serious and life threatening current and present condition. Circumcision should not be done at all on healthy infants, and to do otherwise, no matter how painless it is, is wrong and should be illegal. All of the pain relief in the world will not change the fact that the infant is being deprived of a totally normal and healthy part of his body and 90% of his sexual sensitivity. If we are going to want to build a safer, happier more peaceful world, we must stop mutilating and making war on the bodies of our children, assaulting them and violating their rights. Even with anesthetic, circumcision is still an assault. If someone drugged an adult and then when they were out cut off parts of their body, it would still be an assault, since it is wrong to amputate body parts of unconsenting people regardless of whether anesthetic is used.

People should not think that by using anesthetics the problems with circumcision have been fixed. They have not. The only way to fix the problem is to not mutilate the children at all. Dont fall for the tricks to make us think that by making these changes in anesthetic use, which are meant to divert our attention from the fact that the very infliction of circumcision is wrong, that the problems have been solved. Its still mutilation, and the only way to stop the mutilation is to stop circumcising.

[Stardust27]

Please note that the numbers in that article don't relate to circumcisions done with anaesthetic, but to training programs for circumcisions which teach using anaesthetic.

Once these doctors get out of training, there's no guarantee that they carry on using the anaesthetic. If they end up at a hospital that says: "Anaesthesia for circumcision? You must be joking!", they'll most probably stop using it.

And even if all doctors coming from these training programs continue to use anasthesia, there's still loads and loads of older doctors, who learned it "differently" (namely: without).

So, these numbers are in no way a reflection of how many circumcisions in the US are actually done with anaesthesia.

Moreover, it says: "Of these same programs that taught circumcision, the anesthetic techniques were used frequently or always in only 84%."

What's "frequently"? How many were "frequently" and how many were "always"?

Probably some helpful tips for discussions with pro-circers who turn this into "97% of circumcisions are done with anasthesia now, so where's the problem?".

Stardust

PS: What's much better news is that less than half of PED training programs teach circumcision at all.