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Pain During Circumcision
Pain During Mogen or PlastiBell Circumcision. Taeusch HW, Martinez AM, Partridge J.C, et al. J Perinatol (April/May 2002); 22:214-8.
We studied two commonly used techniques for circumcision to determine which was associated with less pain and discomfort. In a randomized, prospective, but not blinded study, newborns were circumcised either by Mogen clamp or by PlastiBell. All received dorsal nerve blocks with lidocaine. Fifty-nine well, term newborn infants at San Francisco General Hospital were studied from 1997 to 1998. Circumcisions were carried out mostly by interns and residents in family practice and pediatrics. Pain was assessed by measuring duration of the procedure and by a simple behavioral score done sequentially.
RESULTS: Dorsal nerve blocks were judged to be fully effective in over 70% of cases. Neither Mogen nor PlastiBell was associated with greater pain per 3-minute time period, but the PlastiBell technique on average took nearly twice as long as the Mogen procedure (20 vs 12 minutes). We judged that 60% of the infants had pain or discomfort associated with the procedure that was excessive. Residents and interns universally preferred the Mogen technique over the PlastiBell because of the former's simplicity.
CONCLUSION: During the procedure, Mogen circumcision is associated with less pain and discomfort, takes less time, and is preferred by trainees when compared with the PlastiBell.
Comment. This article was included for discussion because of what’s not told in the abstract. The main reason that the Mogen procedure was quicker in this study was that it was performed without performing a dorsal slit of the foreskin and retracting it to confirm that no adhesions remained before applying the clamp. Included in the Mogen group were 2 infants who had repeat circumcisions performed to remove additional foreskin. These infants still appeared uncircumcised after the initial procedure due to "fear of amputation of the glans" if more foreskin was removed. In fact, after completion of the study, the authors reported an incident of partial glans amputation during a Mogen circumcision. They have since modified their technique for Mogen circumcisions to include the dorsal slit and retraction of the foreskin. I believe that if adequate local anesthesia is used, the type of circumcision performed (and the time required) becomes less important. Certainly, if experienced providers had been performing the bulk of the circumcisions in this study (rather than interns and residents), then the times required would have been much shorter, and the difference less significant. Those physicians preferring to use the Mogen clamp should be aware of the potential risk of partial glans amputation if the adhesions between the glans and the foreskin are not successfully lysed prior to applying the clamp. ABK
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