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Re: Neonatal circumcisionFrom: Arthurfree@aol.comTue Jan 14 23:11:19 1997
I routinely use the method discussed by Ira below (though I tend to use 0.5cc). The injection is immediately subcutaneous, and the skin is so thin that it's very easy to see you're in the right layer, especially if you raise a wheal as you go in. The critical issue for effectiveness is that it is a regional block (takes time to percolate to the cutaneous nerves), as such one must wait for it to take effect. By waiting ten minutes it is effective for me over 70% of the time (as demonstrated by no scream when the first clamp goes on before any traction). As for the time issue: I examine the infant, inject, examine the mother, discuss child care issues, wheel the critter back to the nursery, do my charting, then do the circ. It's usually at least ten minutes since the injection by the time I get a clamp on, and most mothers are happy to help immobilize the knees during the injection when they understand it is to decrease the pain associated with the procedure. Arthur Freeland Warrensburg Missouri
>I routinely use 0.8 cc of 1% lidocaine without epinephrine. I inject 0.4 cc
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