Outcome measures said to have been investigated included heart rate, respiratory rate, oxygen saturation, palmar sweat, sleep-wake state, crying, motor responses, and methemoglobin level. Only heart rate, crying, and methemoglobin levels were re- ported, and the reader assumes that no significant changes were found in the remaining parameters. We applaud the efforts of Lander et al to encourage the use of anesthesia for neonatal circumcision. However, we have observed that many physicians resist using such anesthesia in their practices, likely related to the erroneous belief that it adds much time to the circumcision procedure. Nontheless, as more parents become aware of its availability and effectiveness, more physicians become proponents of its value and expert in its use.
All evidence indicates that such anesthesia does decrease the pain and stress on the infant.
E. O. Horger III, MD Columbia, SC Robert M. Arnett, MD Spartanburg, SC J. Stephen Jones, MD Greenville, SC 1. Lander J, Brady-Fryer B, Metcalfe JB, Nazarali S, Muttitt S. Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision. Am J Obstet Gynecol. Dr. Lander and colleagues have corroborated earlier work documenting that significant pain is experienced during neonatal circumcision, especially when performed without anesthetic, and they are to be commended for recognizing that this pain should be con- sidered. In recommending that anesthetic should be administered during the neonatal period, the authors have failed, however, to note that the pain of circumcision would be more effectively addressed if the operation were postponed to a later age.