Applying the Cream

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How to Apply the Anaesthetic Cream

Removal of the foreskin is part of the Plastibell procedure, so that when the procedure is over, circumcision is complete. Before the circumcision a generous amount of anaesthetic cream should be applied to the whole outside of the penis from base to tip so you can’t see any skin. Once that area is thickly coated with cream, wrap with cling-wrap (to keep the cream in place and not out in the nappy where it is wasted). The cling-wrap must be left open at the free end so that urine can pass through. It is important to check the cream once or twice over these two hours and add more if necessary. The cream is slowly absorbed over that two hour period so that if he has had lots of cream on for two hours he should not feel any pain.

Important – Please read:

Some people are under the impression that there is no cutting involved and that is not so. It is normal practice to cut off the surplus foreskin however not until after the circulation is cut off. If that is not done there is more chance of infection as it is too difficult to keep clean. Last Advice: Please try not to feed him for two hours before his circumcision. That way, he is less likely to wee, or poo, or throw-up, and also a feed immediately afterwards will help settle him down rapidly.

The Three Types of Analgesia for Circumcision

1. Anaesthetic cream

This is an effective and safe form of anaesthesia for circumcision. We like the cream to be applied two hours before the procedure. There is a video on our website that demonstrates the technique.
In summary, apply a generous amount of cream to the whole outside of the penis from base to tip so that you can’t see skin, then wrap it in cling wrap (to keep the cream in place and not out in the nappy where it is wasted). The cling wrap is left open at the free end so that urine can pass through. It is important to check the cream once or twice over the two hours to make sure it is still in place and top it up if necessary. The cream is slowly absorbed over the 2 hour period so that if he has had lots of cream on for two hours he should not feel pain. By the time the anaesthetic wears off, the tissue beyond the string is dead so that discomfort is minimal.

2. Pethidine

Boys over 3 months of age and >6 kgs may be given an injection of pethidine in their arm or leg prior to the procedure in consultation with their parents and treating doctor.

The purpose of giving the pethidine is to give extra analgesia and provide a sedative effect. It is an effective adjunct to anaesthetic cream. It is a possible consequence of any sedative that they become so sedated they can stop breathing. This is extremely rare but you need to be aware of it. It is normal for all babies to sleep after the procedure (whether they have had pethidine or not) we just ask that if they have had pethidine they remain in the care of one of their parents for the next 5-6 hours.

3. Local anaesthetic injection

If felt necessary in boys greater than 12 months old local anaesthetic may also be injected circumferentially around the foreskin during the procedure. This is painless as the area is already numb, but may cause local swelling and bruising. This is of no consequence.