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Anna Taddio, BScPhm, MSc, PhD; Neil Pollock, MD; Cheryl Gilbert-MacLeod, MA, PhD; Kristina Ohlsson; Gideon Koren, MD

Arch Pediatr Adolesc Med. 2000;154:620-623.

Background  Pain of circumcision is only partially relieved by single modalities, such as penile nerve block, lidocaine-prilocaine cream, and sucrose pacifiers.

Objective  To assess the effectiveness of a combination of interventions on the pain response of infants undergoing circumcision.

Methods  Cohort study. Group 1 included infants circumcised using the Mogen clamp and combined analgesics (lidocaine dorsal penile nerve block, lidocaine-prilocaine, acetaminophen, and sugar-coated gauze dipped in grape juice). Group 2 included infants circumcised using the Gomco clamp and lidocaine-prilocaine. Infants were videotaped during circumcision, and pain was assessed using facial activity scores and percentage of time spent crying.

Results  There were 57 infants in group 1 and 29 infants in group 2. Birth characteristics did not differ between groups. Infants in group 1 were older than infants in group 2 (17 days vs 2 days) (P<.001). The mean duration of the procedure was 55 seconds and 577 seconds for infants in group 1 and 2, respectively (P<.001). Facial action scores and percentage of time spent crying were significantly lower during circumcision for infants in group 1 (P<.001). The percentage of time spent crying was 18% and 40% for infants in groups 1 and 2, respectively. No adverse effects were observed in infants in group 1; 1 infant in group 2 had a local skin infection.

Conclusions  Infants circumcised with the Mogen clamp and combined analgesia have substantially less pain than those circumcised with the Gomco clamp and lidocaine-prilocaine cream. Because of the immense pain during circumcision, combined local anesthesia and analgesia using the Mogen clamp should be considered.

From the Departments of Pharmacy (Dr Taddio and Ms Ohlsson) and Paediatrics (Dr Koren), The Hospital for Sick Children, Toronto, Ontario; the Pollock Clinics, Vancouver, British Columbia (Dr Pollock); and the Department of Psychology, IWK Grace Health Centre, Halifax, Nova Scotia (Dr Gilbert-MacLeod).

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