Pain: Difference between revisions

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There are four painful steps in every infant circumcision:

# Before circumcision surgery can commence, the surgeon must first forcibly separate these two highly innervated body parts in an exquisitely painful procedure by ~~the passage of~~ a blunt probe between the two parts to rip and tear the [[synechia]] apart.<ref>{{REFjournal

# Before circumcision surgery can commence, the surgeon must first forcibly separate these two highly innervated body parts in an exquisitely painful procedure by forcing a blunt probe between the two parts to destroy, rip and tear the [[synechia]] apart.<ref>{{REFjournal

|last=Oliver

|init=JE

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|DOI=

|accessdate=2020-11-08

}}</ref> Nervous tissue requires a large blood supply, so the foreskin is richly ~~vascular~~ with many blood vessels,<ref name="fleiss-hodges-vanhowe1998">{{REFjournal

}}</ref> Nervous tissue requires a large blood supply, so the foreskin is richly vascularized with many blood vessels,<ref name="fleiss-hodges-vanhowe1998">{{REFjournal

|last=Fleiss

|init=P

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# Finally, in another, painful step, the foreskin must be cut away.

Lander ''et al''. (1997) conducted a comparison ~~of no~~ anesthesia (current practice in 1997), ring block, dorsal penile nerve block, and a topical eutectic mixture of local anesthetics (EMLA).

Lander ''et al''. (1997) conducted a comparison neonatal non-therapeutic circumcision without anesthesia (current practice in 1997), ring block, dorsal penile nerve block, and a topical eutectic mixture of local anesthetics (EMLA).<ref name="lander1997">{{REFjournal

With no anesthesia, the infants cried continuously. Newborns in the untreated placebo group exhibited homogeneous responses that consisted of sustained elevation of heart rate and high pitched cry throughout the circumcision and following. Two newborns in the placebo group became ill following circumcision (choking and apnea).

EMLA was the least effective pain control. Dorsal penile nerve block (DPNB) was more effective, and ring block was the most effective. The authors reported "[w]ithout exception, newborns in this study who did not receive an analgesic suffered great distress during and following the circumcision, and they were exposed to unnecessary risk (from choking or apnea)." The authors were so alarmed that they terminated the no anesthesia arm of the study early.

None of the analgesic measures tested provided total pain relief. Any infant boy who undergoes neonatal circumcision will experience some pain and trauma. Boys who escape circumcision would have no pain or trauma. The author concluded that circumcision should be performed with anesthetic.<ref name="lander1997">{{REFjournal

|last=Lander

|init=J

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|DOI=

|accessdate=2020-11-10

}}</ref>

With no anesthesia, the infants screamed continuously. Newborns in the untreated placebo group exhibited homogeneous responses that consisted of sustained elevation of heart rate and high pitched cry throughout the circumcision and following. Two newborns in the placebo group became ill following circumcision (choking and apnea).<ref name="lander1997" />

EMLA was the least effective pain control. Dorsal penile nerve block (DPNB) was more effective, and ring block was the most effective. The authors reported "[w]ithout exception, newborns in this study who did not receive an analgesic suffered great distress during and following the circumcision, and they were exposed to unnecessary risk (from choking or apnea)." The authors were so alarmed that they terminated the no anesthesia arm of the study early.<ref name="lander1997" />

None of the analgesic measures tested provided total pain relief. Any infant boy who undergoes neonatal circumcision will experience some pain and trauma. Boys who escape circumcision would have no pain or trauma. The author concluded that circumcision should be performed with anesthetic.<ref name="lander1997" />

===Post-surgical pain===

@@ Line 25: / Line 25: @@
 There are four painful steps in every infant circumcision:
-# Before circumcision surgery can commence, the surgeon must first forcibly separate these two highly innervated body parts in an exquisitely painful procedure by the passage of a blunt probe between the two parts to rip and tear the [[synechia]] apart.<ref>{{REFjournal
+# Before circumcision surgery can commence, the surgeon must first forcibly separate these two highly innervated body parts in an exquisitely painful procedure by forcing a blunt probe between the two parts to destroy, rip and tear the [[synechia]] apart.<ref>{{REFjournal
   |last=Oliver
   |init=JE
@@ Line 79: / Line 79: @@
   |DOI=
   |accessdate=2020-11-08
-}}</ref> Nervous tissue requires a large blood supply, so the foreskin is richly vascular with many blood vessels,<ref name="fleiss-hodges-vanhowe1998">{{REFjournal
+}}</ref> Nervous tissue requires a large blood supply, so the foreskin is richly vascularized with many blood vessels,<ref name="fleiss-hodges-vanhowe1998">{{REFjournal
   |last=Fleiss
   |init=P
@@ Line 116: / Line 116: @@
 # Finally, in another, painful step, the foreskin must be cut away.
-Lander ''et al''. (1997) conducted a comparison of no anesthesia (current practice in 1997), ring block, dorsal penile nerve block, and a topical eutectic mixture of local anesthetics (EMLA).
+Lander ''et al''. (1997) conducted a comparison neonatal non-therapeutic circumcision without anesthesia (current practice in 1997), ring block, dorsal penile nerve block, and a topical eutectic mixture of local anesthetics (EMLA).<ref name="lander1997">{{REFjournal
-With no anesthesia, the infants cried continuously. Newborns in the untreated placebo group exhibited homogeneous responses that consisted of sustained elevation of heart rate and high pitched cry throughout the circumcision and following. Two newborns in the placebo group became ill following circumcision (choking and apnea).
-EMLA was the least effective pain control. Dorsal penile nerve block (DPNB) was more effective, and ring block was the most effective. The authors reported "[w]ithout exception, newborns in this study who did not receive an analgesic suffered great distress during and following the circumcision, and they were exposed to unnecessary risk (from choking or apnea)." The authors were so alarmed that they terminated the no anesthesia arm of the study early.
-None of the analgesic measures tested provided total pain relief. Any infant boy who undergoes neonatal circumcision will experience some pain and trauma. Boys who escape circumcision would have no pain or trauma. The author concluded that circumcision should be performed with anesthetic.<ref name="lander1997">{{REFjournal
   |last=Lander
   |init=J
@@ Line 158: / Line 152: @@
   |DOI=
   |accessdate=2020-11-10
 }}</ref>
+With no anesthesia, the infants screamed continuously. Newborns in the untreated placebo group exhibited homogeneous responses that consisted of sustained elevation of heart rate and high pitched cry throughout the circumcision and following. Two newborns in the placebo group became ill following circumcision (choking and apnea).<ref name="lander1997" />
+EMLA was the least effective pain control. Dorsal penile nerve block (DPNB) was more effective, and ring block was the most effective. The authors reported "[w]ithout exception, newborns in this study who did not receive an analgesic suffered great distress during and following the circumcision, and they were exposed to unnecessary risk (from choking or apnea)." The authors were so alarmed that they terminated the no anesthesia arm of the study early.<ref name="lander1997" />
+None of the analgesic measures tested provided total pain relief. Any infant boy who undergoes neonatal circumcision will experience some pain and trauma. Boys who escape circumcision would have no pain or trauma. The author concluded that circumcision should be performed with anesthetic.<ref name="lander1997" />
 ===Post-surgical pain===