Circumcision and Pain?

[jodyangel, RN]

Ok so witnessed my first circumcision the other day.

I have to say...I hope I don't have to see another. The doctor used nothing for pain while he put hemastats and cut the babys foreskin. The baby was screaming..and all I could give him was a pacifer with sugar? Seriously??

Is this common practice?

[RNlovesherPharmD]

No. Our pediatricians use Tylenol PO and lidocaine locally

[jodyangel, RN]

Well they get 0.5 mls of Tylenol after...but that's not helpful during the painful part : (

[klone, MSN, RN]

Are you sure he didn't give a dorsal penile nerve block (local anesthetic injection, usually with lidocaine) beforehand? It's usually given about 3-5 minutes before the actual procedure. If not, that's barbaric, and totally against AAP recommendations.

No, that's absolutely NOT common practice to do a RIC without local anesthetic.

[jodyangel, RN]

Nope he gave nothing.

[jodyangel, RN]

Trust me it made a Negative impression on me..

[jodyangel, RN]

He was chatting away about Christmas...not even hardly looking down at the screaming newborn..

[klone, MSN, RN]

I would question him next time. You need to be a patient advocate, and what he did was WRONG and barbaric, and out of date, and against AAP recommendations, and WRONG. Someone needs to let him and your unit and your nurse manager know that this is not okay.

[jodyangel, RN]

Well I'm new..on orientation...and this is their Only OB. I don't know what most OBs do..that's why I asked..

[jodyangel, RN]

I just kept thinking...this is Crao if you don't believe that baby is feeling pain!

[Calabria, BSN, RN]

Ok so witnessed my first circumcision the other day.

I have to say...I hope I don't have to see another. The doctor used nothing for pain while he put hemastats and cut the babys foreskin. The baby was screaming..and all I could give him was a pacifer with sugar? Seriously??

Is this common practice?

Absolutely not.

We have standing orders for sucrose PO, lidocaine (administered as a local anesthetic), and Tylenol (which can be given for 24 hours after the procedure).

Sometimes, I question the effectiveness of the above combination... especially if we have an impatient doctor who doesn't wait long enough for the lidocaine to take effect. But that's a conversation for another day.

[Calabria, BSN, RN]

Also, OP, does your facility use a pain scale for infants? We are required to document pain levels in the infant before and after the procedure, and what interventions were used to help with pain.