Pain: Difference between revisions
WikiModEn2 (talk | contribs) →Intraoperative pain: Add citation. |
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# Finally, in another, painful step, the foreskin must be cut away. | # Finally, in another, painful step, the foreskin must be cut away. | ||
Lander | 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 | ||
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Circumcision is an invasive cutting and amputation. Like other invasive operations, post-surgical pain persists after the surgery for days or weeks. Infant boys will not receive effective analgesia because their young age makes such drugs dangerous. | Circumcision is an invasive cutting and amputation. Like other invasive operations, post-surgical pain persists after the surgery for days or weeks. Infant boys will not receive effective analgesia because their young age makes such drugs dangerous. | ||
Howard | Howard et al. (1994) studied male infants after their neonatal circumcision. They recorded the comfort scores of the infants at numerous periods after circumcision. They also observed and recorded feeding behavior. | ||
It was found that feeding behavior deteriorated significantly after circumcision. Some breastfeed infants were unable to breastfeed and required formula feeding after circumcision. Acetaminophen was found to be almost totally ineffective against the post-circumcision pain. It did have some effect six hours after the circumcision. The authors concluded "that circumcision of the newborn causes severe and persistent pain."<ref name="howard1994">{{REFjournal | It was found that feeding behavior deteriorated significantly after circumcision. Some breastfeed infants were unable to breastfeed and required formula feeding after circumcision. Acetaminophen was found to be almost totally ineffective against the post-circumcision pain. It did have some effect six hours after the circumcision. The authors concluded "that circumcision of the newborn causes severe and persistent pain."<ref name="howard1994">{{REFjournal | ||
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}}</ref> showing that the nervous system had been permanently sensitized to heightened pain sensation. | }}</ref> showing that the nervous system had been permanently sensitized to heightened pain sensation. | ||
Taddio | Taddio et al. (1997) concluded: | ||
<blockquote> | <blockquote> | ||
Although postsurgical central sensitisation (allodynia and hyperalgesia) can extend to sites of the body distal from the wound, suggesting a supraspinal effect, the long-term consequences of surgery done without anaesthesia are likely to include post-traumatic stress as well as pain. It is, therefore, possible that the greater vaccination response in the infants circumcised without anaesthesia may represent an <u>infant analogue of a post-traumatic stress disorder</u> triggered by a traumatic and painful event and re-experienced under similar circumstances of pain during vaccination.<ref name="taddio1997" /> | Although postsurgical central sensitisation (allodynia and hyperalgesia) can extend to sites of the body distal from the wound, suggesting a supraspinal effect, the long-term consequences of surgery done without anaesthesia are likely to include post-traumatic stress as well as pain. It is, therefore, possible that the greater vaccination response in the infants circumcised without anaesthesia may represent an <u>infant analogue of a post-traumatic stress disorder</u> triggered by a traumatic and painful event and re-experienced under similar circumstances of pain during vaccination.<ref name="taddio1997" /> | ||
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Flechsig's bizarre opinion was not questioned until the 1970s. Several lines empirical of research carried out in the 1970s suggested that infants can in fact feel intense pain. | Flechsig's bizarre opinion was not questioned until the 1970s. Several lines empirical of research carried out in the 1970s suggested that infants can in fact feel intense pain. | ||
* Anders | * Anders et al. (1970) showed that measurement of serum cortisol is a useful indicator of pain for psychological investigation in infancy.<ref name="anders1970">{{REFjournal | ||
|last=Anders | |last=Anders | ||
|init=TF | |init=TF | ||
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}}</ref> | }}</ref> | ||
* Emde | * Emde et al. (1971) showed that the "stress" of circumcision caused an increase in the amount of non-REM sleep.<ref name="emde1971">{{REFjournal | ||
|last=Emde | |last=Emde | ||
|init=RN | |init=RN | ||
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}}</ref> | }}</ref> | ||
* Gunnar | * Gunnar et al. (1981) recorded serum cortisol and behavior state throughout the unanesthetized, non-therapeutic circumcision process. Serum cortisol levels and behavioral distress were found to be closely related. The authors stated: | ||
<blockquote> | <blockquote> | ||
Neonatal circumcision is performed without anesthesia and it is clearly stressful for the infant. | Neonatal circumcision is performed without anesthesia and it is clearly stressful for the infant. | ||
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}}</ref> | }}</ref> | ||
* Marshall | * Marshall et al. (1982) studied mother-child interaction with regard to feeding behavior after circumcision without anesthesia. They found that circumcised boys had more interruptions of feeding in the 24-hour period of observation.<ref name="marshall1982">{{REFjournal | ||
|last=Marshall | |last=Marshall | ||
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</blockquote></i> | </blockquote></i> | ||
Gunnar | Gunnar et al. (1988) examined the association between behavioral distress and adrenocortical activity. It was found that differences in behavioral distress did not reliably the level of adrenocortical activity. Moreover, it was found that while non-nutritive sucking reduces crying it did not reduce the adrenocortical response to the stressful stimulus of circumcision pain.<ref name="gunnar1988">{{REFjournal | ||
|last=Gunnar | |last=Gunnar | ||
|first=Megan | |first=Megan | ||
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}}</ref> | }}</ref> | ||
* Ring Block. Broadman | * Ring Block. Broadman et al. (1987) proposed ring block for neonatal non-therapeutic circumcision.<ref name="broadman1987">{{REFjournal | ||
|last=Broadman | |last=Broadman | ||
|init=LM | |init=LM | ||