Should my baby have anesthesia or pain medication for the circumcision?

Among the methods of reducing pain during and after circumcision are topical anesthetics, oral analgesics, and the Mohel's traditional choice of sweet wine. The benefits of anesthetics and pain medication are well understood, but research articles show that there are risks of negative side effects from both.

Very young children may be especially sensitive to the effects of lidocaine and prilocaine, according to USP DI-Volume II Advice for the Patient: Drug Information in Lay Language, Edition 17, 1997 p1003(3), copyright 1997 United States Pharmacopeial Convention, Inc. Lidocaine and prilocaine are ingredients of topical anesthesia preparations such as the Emla brand. The incision area, and the possibility of diaper rash and the presence of broken skin, increase the possibility of negative side effects from local anesthetics of this kind.

Acetaminophen is often used to reduce pain, but research shows a disturbing level of risk associated with Tylenol and other medicines containing acetaminophen. Edwin W. Brown's article "Tylenol is not the "harmless" alternative to aspirin", copyright 1996 Medical Education and Research Foundation mentions FDA reports that at least 33 American children below age 13 have died of acetaminophen poisoning from 1970 to 1991; 152 others suffered serious consequences that required hospitalization, and sometimes produced permanent disability. Another article by Child Health Alert Inc. quotes Dr. William Lee, a professor of internal medicine at the university of Texas Southwestern Medical Center in Dallas, saying "No other over-the-counter drug has a narrower range between therapy and toxicity than acetaminophen." The same article quotes Dr. Anthony Temple, medical director of the Johnson & Johnson subsidiary that produces Tylenol. How low of a dose poses a potential risk to children? "We don't know." These ideas are discussed in the article J&J's Dirty Little Secret, by Thomas Easton and Stephen Herrera. Click here for the full text of the article.

The British Medical Journal No 6993 Volume 310, 1995, includes a paper reporting on the analgesic affect of sucrose (sugar) and declares it an effective pain killer for babies. The authors of the paper gave sugar in the form of 2 mls of 50 per cent sucrose by mouth to 30 babies just before they had a routine blood test to detect jaundice. The babies cried less and had a faster return to normal heart rate after the painful prick in the foot than the 30 babies who were given only plain water. Click here for the full text of the article. The sweet wine used by a Mohel to comfort the baby after the circumcision appears to be an effective and safe pain-killer for young babies as well.