At the Perth Circumcision Clinic we offer the parents CHOICE as to the type of anaesthetic and pain relief that they want for their child.
1. No Anaesthetic When a circumcision is performed with the technique used in the Perth Circumcision Clinic, the entire procedure takes less than 60 seconds. It is quick, simple and safe and the child settles back down after this period of distress after a further 1 to 15 minutes. The child of 5 days of age in particular, settles in a few seconds. He has very rudimentary intellectual capacity and awareness, and holds distress for a very brief period. Children up to 6 weeks of age have not been demonstrated to have any memory, but get progressively more aware of their environment after that age. Earliest recorded memory relates to awareness of the mother as distinct from others at 6 – 8 weeks of age. If you do not wish any anaesthetic for your child, as has been done for many thousands of years without great consequence, we will respect your choice.
2. Local Anaesthetic Creams The most common of these are EMLA and LMX4 cream. At the Perth Circumcision Clinic, LMX4 is offered to parents as a choice to apply after arrival at the clinic, approximately 15 - 30 minutes before the procedure. We will supply and apply the cream. It can be used to reduce the sensation at the tip of the penis and/or for the purpose of making the child almost unaware of the use of the regional block (see below).
3. Local Anaesthetic Injections Local anaesthetic can be injected under the skin either as a dorsal nerve block (centrally over the top of the penis near to its base to anaesthetise the dorsal nerve of the penis) or as a ring block (several injections around the middle of the shaft of the penis subcutaneously). This is by far the most successful local anaesthetic technique available, and is used commonly around the world. It is particularly important where the techniques used require more than a few minutes operating time. Please note that these injections are not always perfectly effective, can have complications of swelling and bleeding, and in themselves can be uncomfortable for the child. Also, the practitioner should wait 5 to 10 minutes for them to be fully effective. At the Perth Circumcision Clinic, we offer parents the choice to have this regional block applied to reduce the discomfort for their child. We would apply the local anaesthetic cream first to the base of the penis and later the regional block. In this way, most babies do not feel the procedure at all.
4. General Anaesthetic For children over the age of 6 months, general anaesthesia is the preferred method of anaesthetic routinely used in most parts of the world. A General Anaesthetic is not without its risks, but children of these ages are intellectually complex, retain memory and distress for long periods and should have effective anaesthesia. On balance, it is preferable to get the circumcision performed in the neonatal period using the simpler neonatal procedure. Circumcision for older children and adults is not available at the Perth Circumcision Clinic. If your child is older than eight weeks of age, then please call us and make an appointment with no out of pocket expense, with our doctor to advise how to access a reliable and safe circumcision for your child.
5. Sucrose Syrup Surcrose Syrup has been said to have minor analgesic benefit. Therefore at Perth Circumcision Clinic we use it immediately after the procedure to help settle the baby more quickly.