A Pictorial and Video Guide to Circumcision Without Pain

Nancy L. Kraft, RNC, MSN, NNP


Adv Neonatal Care. 2003;3(2) 

In This Article

Analgesic Options: Evaluating the Effectiveness of Acetaminophen

The efficacy of acetaminophen (Tylenol; McNeil Pharmaceutical, Raritan, NJ) to relieve pain during and after circumcision has been evaluated in 2 prospective, randomized, double-blind, placebo-controlled clinical trials of healthy male newborns (total combined, n = 104).[8,65] Both investigations showed acetaminophen administered at the usual dose of 10 to 15 mg/kg/dose by mouth 1 to 2 hours before circumcision is not effective for pain control during the procedure.

The findings related to effective relief of postoperative pain were mixed. The 1994 study did not show effectiveness in the immediate postoperative period, but higher comfort scores were noted 6 hours after circumcision.[65] In the 2001 study, infants who received acetaminophen had a significant decrease in the amount of crying time associated with diaper changes 1 hour after circumcision.[8] Acetaminophen also improved mother-infant interaction during the first feeding after circumcision. Its use "permitted the newborns to demonstrate clearer cues and respond more to their mothers, who in turn were more responsive to them."[8]

Postoperative pain control is an important component of care. Acetaminophen has been shown to be safe and effective for the relief of mild to moderate pain in the newborn period.[66,67] Prescribers should be aware that the theoretic potential to induce methemoglobinemia exists, and concurrent use of acetaminophen and EMLA could potentially increase the risk of developing this condition.[68]


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