Baseline studies were designed to measure an infants discomfort during a circumcision, measuring the child's heart rate, respiratory rate and serum cortisol, the chemical responsible for the exercise high we often feel. Also, gross observations were made as to if the baby cried, arched his back or moved around. These studies concluded that the infant definitely feels discomfort during circumcision.

With known baseline studies, infants were then studied in several ways including the infant sucking a sucrose solution and during circumcision with different anesthesia techniques. Most studies suggested that the best technique reported was a circumferential ring block at the base of the penis. A dorsal penile nerve block (DPNB) second best and the use of EMLA cream a distant third. Recent studies suggest that sucking on a glucose solution may be as affective as applying EMLA. Because of these findings, in 1999, the American Academy of Pediatrics (AAP), in their once-in-a-decade policy statement on circumcision recommended that anesthesia be administered with neonatal circumcision.

While using all of the above techniques I noticed that, regardless of the technique, an infant might start crying during the middle of the Brit milah ceremony and continue to cry for over one-half hour. This was discouraging. I was in favor of anesthesia, which certainly worked for the circumcision, but unfortunately, was the cause of later discomfort which interfered with the brit and persisted after the ceremony. It was particularly disturbing when the rabbi and my temple announced that, "Doctor Kunin's brisses never cry." And to make things worse, it was the president of the temple's grandson.

Shortly after that, I had dental work done. When I felt the numbness and tingling sensation of the anesthesia wearing off, I realized that this is what the babies were feeling and, having no other way to communicate, cried until the anesthesia had completely worn off.

With this in mind, I was determined to find a way to administer anesthesia without the side affect of an irritable focus caused by the wearing off of anesthesia. I was using the ring block at that time but discarded it. Requiring an anesthetic technique that would leave no anesthesia after the circumcision, I decided to only inject the tip of the foreskin distal to the circumcision site. Therefore, the lidocaine was only in the skin that was to be removed. There was a chance that the anesthetic might not be as effective as other modalities, but I was willing to chance it in exchange for a comfortable baby during and after the ceremony.

Little did I realize that this technique would be as affective as the other techniques with virtually no chance for side affects. Of course, the irritable focus was no longer a worry. Also, using this technique in the hospital, the nurses said they appreciated the fact that the babies did not cry once they were returned to the nursery.

Common side affects like hematomas, infection and absorption of lidocaine with rare potential for convulsions or blood defects became nonexistent.

Studying the first 626 cases, I found that 85% of the infants never cried with injection, 14+% whimpered for a few seconds before going back to sucking sucrose solution and less than 1% actually cried. This certainly dispels claims of some circumcisers that the anesthetic is more painful than the circumcision itself.

Originally, I devised this method with my grandchildren in mind. I have used it on them as well as more than 3000 circumcisions.

Although this is my anesthetic technique of choice, I must conclude that ANY anesthetic is better than nothing at all and heartily recommend its use. This technique particularly works well with Gomco and Plastibell Clamps and is now being used by several of my colleagues.

In another section of the web site, designed for physicians, a copy of my first paper is listed. However, most of the salient facts are summarized above.