No abstract

Male circumcision (MC) is one of the oldest and most common operations performed all over the world. It can be performed at different ages, using different surgical techniques, for different religious, cultural and medical reasons.Our aim is to examine and compare the various methods of analgesia and different surgical procedures reported in literature that are applied in infant MC. We performed a PubMed, MEDLINE, EMBASE and Cochrane search in the papers published since 2000: 14 studies met the inclusion criteria, most of them showing that a combined pharmacological and non-pharmacological intervention is the best analgesic option, in particular when the dorsal penile nerve block is combined with other treatments. The Mogen surgical procedure seems to be the less painful surgical intervention, when compared with Gomco clamp or PlastiBell device. Only 3 papers studied groups of at least 20 babies each with the use of validated pain scales. Data show a dramatic decrease of pain with dorsal penile nerve block, plus acetaminophen associated to oral sucrose or topic analgesic cream. However, no procedure has been found to definetively eliminate pain; the gold standard procedure to make MC totally painfree has not yet been established.

A large amount of analgesic methods was used, making comparisons difficult. Nevertheless, in the absence of analgesic treatment, heelpricks and venipunctures are moderately-severely painful, and among the proposed analgesic procedures, few seem to be effective.

Fetal programming occurs when the normal pattern of fetal development is disrupted by an abnormal stimulus or an ?insult? during intrauterine life, which leads to adaptations by the fetus to allow its survival but could finally result in permanent structural and physiological changes with long-term consequences in adulthood. The availability of nutrients, hormones, and respiratory gases is the principal determinant of fetal growth and offspring's subsequent health. Fetal nutrient and oxygen availability depend on the rate of transfer across the ?placental barrier.? Nutritional status of the mother is also important: both maternal undernutrition and/or overnutrition during early gestation may increase the incidence of cardiovascular and metabolic disorders in the offspring in later life. Oxidative stress has been supposed to be the link between adverse intrauterine environment and later elevated risks of chronic diseases. It is an important initiating mechanism underlying the programming process due to suboptimal nutrition. Antioxidant vitamins, proteins, and trace elements can be compromised under condition of poor maternal nutrition leading to oxidant/antioxidant imbalance during pregnancy. On the other hand, maternal overnutrition is associated to chronic inflammatory states that increase free radicals' production. Developing dietary strategies to optimize maternal nutrition is necessary to supply the fetus with appropriate substrates and to avoid fetal redox status disruption.