Manual for Male Circumcision under Local Anaesthesia

Male circumcision under local anaesthesia
Version 3.1 (Dec09)
referred to a specialist centre. The circumcision team should
enquire about the health of the baby or young boy.
Neonatal circumcision (within the first 28 days of life) should be
undertaken only if the birth was a full-term delivery and the
baby has had no significant medical problems. Known
haematological disorders and jaundice are contraindications to
circumcision. Thus any baby with yellow sclera or purpuric skin
lesions should not be accepted for clinic-based circumcision.
Any congenital abnormality of the genitalia is a contraindication
to circumcision. Only babies with a normal physical
examination and an intact, completely normal appearing penis
and foreskin should be considered for male circumcision. This
is because the foreskin may be needed for plastic surgical
repair of the abnormality.
CONSENT
In all cases, the procedure can be undertaken only with the full
consent of the parent or legal guardian. The parent or legal
guardian should be fully informed about how the procedure will
be done, what type of anaesthetic will be used, what
complications are possible, and what type of postoperative
care should be provided. A summary of the information that
needs to be provided is given in Appendix 6.1. The consent of
the child should also be obtained, if he is able to give it
(Chapter 3 addresses this issue in more detail). An example of
a consent form is given in Appendix 6.2.
PREPARATION
Before the procedure, the baby should be clean and have a
clean, freshly-laundered or new disposable nappy. Because
mothers may need to travel some distance to the clinic, any
clinic offering infant circumcision should have facilities for
washing babies and changing nappies.
ANAESTHESIA
Anaesthesia is recommended for paediatric circumcision.
Many studies have shown that babies react to pain, and that
an effective method of providing local anaesthesia is with
dorsal penile nerve block. a The maximum safe dose of
lidocaine in children is 3 mg/kg of body weight. For a 3-kg baby,
this corresponds to 0.9 ml of 1% solution or 1.8 ml of 0.5%
solution (see Table 5.1). Anaesthetic solutions containing
epinephrine (adrenaline) should never be used.
a
Kirya C, Werthmann MW Jr. Neonatal circumcision and penile dorsal nerve block: a painless
procedure. J Pediatr. 1978;96:998-1000.
Infant and paediatric circumcision Chapter 6 - 2