Circumcision Anesthesia

For older patients and neonates, circumcision can be performed using a local or regional anesthetic. A general anesthetic is not recommended for a newborn. However, regional techniques can be used to provide postoperative pain relief and to avoid the need to inhale or use airway instrumentation. Furthermore, they may allow the provider to avoid the use of sedatives and other forms of sedation.

Exclusion criteria for circumcision anesthesia

This study assessed the use of regional anesthesia, preoperative examination, intraoperative monitoring, and postoperative analgesia. It also looked at common complications and the effectiveness of these methods. The survey was conducted at the Bulent Ecevit University Hospital in Zonguldak, Turkey. The electronic forms were submitted online and data were collected. Questions included demographics, monitoring methods, and the types of anesthesia agents used.

Most people find the surgery painless. However, some patients may experience severe bleeding. Local anesthesia can produce pressure and movement during circumcision but no pain. Although general anesthesia does not prevent postoperative pain, there may be some discomfort. It can also lead to more serious complications such as a buried penis or epidermal inclusion cysts and urethrocutaneous fistulas.

The Centers for Disease Control and Prevention states that deferring circumcision until adolescence or adulthood obviates concerns about autonomy. Although the medical disadvantages of deferral would be greater, the respect for autonomy is worth the risk. In the United States, for example, circumcision is commonly performed on children. This study supports the idea of waiting until adolescence and adulthood, which is more ethically acceptable.

Superior to ring block: Dorsal penile nerve blocks

A dorsal penile nerve block is a better anesthetic option than a ring. However, a dorsal block has some advantages. The dorsal block is more difficult to place and can result in a needle with a barb. This barb could damage vascular structures and cause a sizeable hematoma.

In one study, lidocaine without epinephrine was administered with a tuberculin syringe and a 27-gauge needle. In the dorsal penile nervous block group, 0.4mL of lidocaine were injected into the penis at the two dorsolateral injection points. In the ring block group, 0.8 mL of lidocaine was injected halfway along the penis shaft. However, the dorsal penile nerve block group had significantly lower heart rates after 15 minutes of anesthetic administration.

Another technique is a subsartorial saphenous nerve blocks. Deep peroneal nerve innervates the first web space of the foot. It is placed lateral to the extensor hallucis longus tendon. The needle is moved until it reaches the periosteum at the tibia. After that, it is slightly drawn back. The nerve block can be identified by following the dorsalis-pedis artery.

Dosing of local anesthetics

One common question about the safety of local anesthetics for circumcision is whether they are safe. Epinephrine has not been approved by the FDA as a vasoconstrictor during circumcision. It is still common to give epinephrine to circumcision. Dosing should be based on the individual patient’s weight and anesthetic tolerance.

The preoperative evaluation should include birth history and medical history, including any previous surgical procedures and medications. Anesthetic risks include hematoma formation, inadvertent injury to the glans, and excessive skin removal. In addition, patients should disclose any bleeding disorders. Babies may find this particularly difficult as they may feel pain during erections, which can cause disruption to the suture line. Afterwards, the child should stay immobile for four to six weeks in order to avoid infection.

While neonates are considered to be little adults, there are a few anatomical differences in the spine that need special attention. In addition to the anatomical differences, the infant’s brain develops its nociceptive system at a different rate than adults. Myelination in neonates is incomplete at birth. However, it takes approximately 12 years for it to fully develop. The newborn’s liver tissue is still not fully mature. Although the nociceptive pathways of neonates are similar to those in adults, there may be greater pain from differences in the nervous systems.