Pain management is often a topic parents and caregivers bring up when asking questions about circumcision. Whether they are scheduling a circumcision for a newborn son or preparing for a Brit Milah, the central concern is the same: will my baby be in pain from the procedure?

The short answer is that newborns do feel pain and the approach taken to manage it matters. GTA Circumcision uses a multimodal or multi-method pain management protocol for every procedure, informed by the same principles that guide pain control in operating rooms.

What a Multimodal Approach Means

A multimodal approach combines several methods of pain control rather than relying on any particular individual method. Each modality or method targets pain differently so the overall effect is greater than any single modality provides on its own.

The methods used at GTA Circumcision are sucrose, local anesthetic injection and acetaminophen. These 3 methods are considered safe when used on their own and when combined together.

Sucrose (oral sugar solution)

A small amount of sucrose solution given orally before and during the procedure can result in newborns being calmed. Research supports its use as an analgesic (pain reliever) in newborn procedures. It does not replace local anesthesia but it reduces distress and helps settle the baby in the time before and during the procedure.

Local anesthetic injection

A local anesthetic or nerve block is injected to block sensation from the penis. This is the primary form of pain control and the step that can significantly reduce the amount of pain your baby feels from the circumcision itself. Proper injection technique and the correct choice of anesthetic are both important for the block to work as intended.

Acetaminophen

Acetaminophen is given to address post-procedural discomfort. Circumcision involves some discomfort postprocedure and acetaminophen helps manage that discomfort at home. Parents are given specific dosing guidance before they leave.

What is an anesthesiologist?

An anesthesiologist is a physician with extensive training in administering anesthesia, managing pain and critical care. Dr. Andrew Suess, MD, FRCPC is a specialist in anesthesiology with fellowship training in pediatric anesthesia. He actively practises in hospital operating rooms and labour and delivery suites. He has experience administering anesthesia to pediatric patients both in hospital and clinic settings.

His clinical experience shaped his approach to newborn and infant circumcision. 

Local anesthetic blocks require a specific technique to be effective. The injection must reach the correct anatomical location in sufficient volume. Dr. Suess has extensive experience performing local anesthetic blocks both using anatomical landmarks and ultrasound guidance. When a penile block is performed correctly, the baby typically feels much less discomfort during the circumcision than were the block to not have been provided. Anesthesiologists routinely use regional blocks and that skill transfers directly to this setting.

Pediatric anesthesia requires meticulous attention to age and weight, dosing, pharmacology interactions and overall management of the case. Dr. Suess applies this same mindset to circumcision.

During the Procedure

Once the local anesthetic is in place and sufficient time has passed for it to take effect, the procedure itself is brief. It is not uncommon for a circumcision to take under 5 minutes from start to finish. The baby is given sucrose to soothe him during the procedure. Parents choose whether they wish to remain in the procedure room for the duration of the circumcision or make themselves comfortable elsewhere in the clinic.

Crying during the appointment is normal. A needle injection, the preparation steps, and the soft physical securing devices involved in any procedural setting may produce a response from a newborn. That response does not necessarily indicate that pain control has failed. 

What to Watch for at Home

Some fussiness in the hours after the circumcision is expected. Acetaminophen dosing for newborns is weight-based and specific instructions are provided before discharge. A small amount of bleeding in the first 24 hours can be expected.. Parents receive written aftercare instructions covering what is normal and abnormal post-circumcision bleeding.

If anything concerns you after arrival at post-circumcision, we have various ways for you to reach us.

Frequently Asked Questions

Will my baby feel pain during and after the circumcision?

With a properly administered local anesthetic, pain your baby may feel during the procedure is significantly reduced.. The multimodal approach addresses both procedural and post-procedural discomfort.

What anesthetic is used?

A local anesthetic injection is used to block sensation in the area of the procedure. The specific dose and technique are determined based on the baby’s age and weight.

What if my baby cries during the procedure?

Crying during a medical procedure does not always indicate pain. Newborns may respond to stimulation, handling, and environmental change with a well-working local anesthetic injection.

How long does the pain management last?

The local anesthetic wears off gradually over hours after the procedure. At times, babies may become irritable, fussy or cry as the local anesthetic is wearing off. Acetaminophen is recommended to manage discomfort if parents are concerned.

Does my baby need a general anesthetic?

No. General anesthesia is not required for newborn circumcision. Local anesthesia with appropriate supportive measures is both sufficient and appropriate for this procedure.