Obstetrics & Gynecology, Volume 91, Issue 6, Pages 930-934. June 1998.
a Department of Obstetrics, Gynecology, and Reproductive Sciences, 
University of Texas Health Science Center at Houston, Houston, Texas, USA
b Department of Pediatric Surgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
OBJECTIVE: To determine whether a difference in the behavioral and physiologic response to circumcision can be demonstrated between neonates undergoing the procedure with ring block and those receiving no anesthesia.
METHODS: Forty healthy male newborns were assigned randomly to receive either ring block or no anesthesia. Indices of perceived pain including crying time, behavioral state, oxygen saturation, and heart and respiratory rates were recorded at baseline and at intervals during the circumcision. Infants were reassessed 2 minutes and 2 hours postoperatively.
RESULTS: Infants receiving ring block cried less than did controls (P < .001). Anesthetized infants had smaller increases in heart rate (P < .005) and demonstrated less arousal (P < .005) during each operative interval. For all operative intervals combined, anesthetized infants had a smaller decrease in oxygen saturation (P < .001) and a smaller increase in respiratory rate (P = .005) than did controls. Two minutes postoperatively, anesthetized infants had returned to their baseline behavioral state, whereas controls remained significantly more aroused (P < .005). Two hours postoperatively, there were no significant differences in any variables between the groups, nor between each group and its baseline. There were no complications related to anesthesia administration.
CONCLUSION: Neonatal circumcision causes behavioral and physiologic changes consistent with the perception of pain. Ring block is an effective method of anesthesia for this procedure.
Received 14 October 1997; revised 23 January 1998; accepted 19 February 1998. Available online 12 January 1999.
Address reprint requests to: Joan M. Mastrobattista, MD, Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of Texas Health Science Center at Houston, 6431 Fannin Street, Suite 3.036, Houston, TX 77030; email: 
jmastrob@obg.med.uth.tmc.edu
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