Comparison of anesthesia onset and duration between needle and needle-free methods in pediatric circumcision
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Introduction: Various anesthesia methods are utilized during circumcision, including needle anesthesia (NA) and needle-free anesthesia (NFA). However, research on differences in the total duration of anesthetic action between these methods remains limited. Therefore, this study aimed to evaluate the effectiveness of NA and NFA techniques in circumcision.
Methods: This observational study employed a prospective cohort design and an independent t-test. A total of 56 participants were included, with 28 patients assigned to each technique. Data collection was conducted using an observation sheet. Consecutive sampling was applied, and the primary variables measured were the onset of anesthetic drug, duration of anesthetic effect, and total duration of anesthetic action.
Results: The onset of anesthetic drug, measured as the time from administration to numbness, averaged 4.53 minutes and 3.14 minutes using the NA and NFA methods, respectively (p<0.001). The average duration of anesthetic effect, measured as the time from the onset of numbness to anesthesia dissipation, was 95.39 minutes and 79.00 minutes in the NA and NFA methods, respectively (p<0.001). Finally, the total duration of anesthetic action was 100.46 minutes and 82.54 minutes using the NA and NFA methods, respectively (p<0.001).
Conclusions: The NFA method facilitates a faster onset, while the NA method provides a longer duration of anesthetic effect. These findings may assist clinicians in selecting anesthesia techniques based on procedural duration and patient comfort in pediatric circumcision. Further studies are suggested to explore other influencing factors.
Akyüz, O. & Ergün, M. (2020) “The Effectiveness of Jet (Needle-Free) Injector to Provide Anesthesia in Child Circumcision under Local Anesthesia,” Journal of Investigative Surgery, 35(1), pp. 44–48. Available at: https://doi.org/10.1080/08941939.2020.1817635.
Alameeri, A.A. et al. (2022) “The feasibility of needleless jet injection versus conventional needle local anesthesia during dental procedures: a systematic review,” Journal of the Korean Association of Oral and Maxillofacial Surgeons, 48(6), pp. 331–341. Available at: https://doi.org/10.5125/jkaoms.2022.48.6.331.
Alifariki, L.O., La Rangki, & Adius Kusnan (2022) “Circumcision Social Service for Poor Families in Andepali Village, Sampara District: Bakti Sosial Khitanan Pada Keluarga Tidak Mampu Di Desa Andepali Kecamatan Sampara,” Mattawang: Jurnal Pengabdian Masyarakat, 3(3), pp. 344–347. Available at: https://doi.org/10.35877/454RI.mattawang1199.
Altan, H. et al. (2021) “Comparative evaluation of pain perception with a new needle-free system and dental needle method in children: a randomized clinical trial,” BMC Anesthesiology, 21(1), p. 301. Available at: https://doi.org/10.1186/s12871-021-01524-1.
Altan, H. & Almas, B. (2025) “Clinical evaluation of different types of injection systems and comparison of pain acceptance in palatal anesthesia in pediatric patients: a randomized controlled split-mouth study,” Journal of Dental Anesthesia and Pain Medicine, 25(3), p. 191. Available at: https://doi.org/10.17245/jdapm.2025.25.3.191.
Altaş, C. et al. (2017) “Anesthesia methods used by anesthetic specialists for circumcision cases: National survey study for Turkey,” Saudi Medical Journal, 38(1), pp. 75–81. Available at: https://doi.org/10.15537/smj.2017.1.15632.
Amorim, K.D.S. et al. (2020) “Palatal needle-free anesthesia for upper molars extraction. A randomized clinical trial,” Journal of Cranio-Maxillofacial Surgery, 48(8), pp. 815–819. Available at: https://doi.org/10.1016/j.jcms.2020.05.001.
Barolet, D. & Benohanian, A. (2018) “Current trends in needle-free jet injection: an update,” Clinical, Cosmetic and Investigational Dermatology, Volume 11, pp. 231–238. Available at: https://doi.org/10.2147/CCID.S162724.
Budiono, B. et al. (2022) “Kontaminasi Sel Darah Merah dengan Sisa Bahan Anestesi dalam Cartridge Pasca Injeksi Anestesi Lokal,” Indonesian Journal of Dentistry, 2(1), p. 24. Available at: https://doi.org/10.26714/ijd.v2i1.9870.
Carreira De Oliveira, D.A. et al. (2025) “Dorsal penile nerve block versus caudal block for circumcision in pediatric patients: A systematic review and meta-analysis,” Trends in Anaesthesia and Critical Care, 61, p. 101543. Available at: https://doi.org/10.1016/j.tacc.2025.101543.
Dahlan, M.S. (2016) Besar Sampel dalam Penelitian Kedokteran dan Kesehatan. Jakarta: Epidemiologi Indonesia.
Eisenberg, M.L. et al. (2018) “The Relationship between Neonatal Circumcision, Urinary Tract Infection, and Health,” The World Journal of Men’s Health, 36(3), p. 176. Available at: https://doi.org/10.5534/wjmh.180006.
Ganeswari, P.A.D., Maheswari, L.M.S. & Puspawati, N.M.D. (2020) “Peranan sirkumsisi dalam pencegahan infeksi menular seksual,” Intisari Sains Medis, 11(3), pp. 1157–1164. Available at: https://doi.org/10.15562/ism.v11i3.835.
Jaju, K.K. et al. (2024) “Comparative Evaluation of the Anesthetic Efficacy of Needle-Free Anesthesia and Conventional Anesthesia in Patients With Symptomatic Irreversible Pulpitis: A Randomized Clinical Trial,” Cureus, 16(2), p. e54661. Available at: https://doi.org/10.7759/cureus.54661.
Jalali, F., Shojaeepour, S. & Shojaiepour, R. (2020) “Comparison of Two Standard Scales for Pain Perception during Local Anesthetic Injection in Children,” Journal of Islamic Dental Association of IRAN, 32(1), pp. 37–42. Available at: https://doi.org/10.30699/jidai.32.1.2.37.
Khoa, L.D. et al. (2019) “Needle‐free jet versus conventional needle injection for local anesthesia in men undergoing surgical sperm retrieval,” Andrology, 7(1), pp. 69–75. Available at: https://doi.org/10.1111/andr.12557.
Mehta, K.S. et al. (2021) “Male circumcision and Sexually transmitted Infections – An update,” Indian Journal of Sexually Transmitted Diseases and AIDS, 42(1), pp. 1–6. Available at: https://doi.org/10.4103/ijstd.ijstd_20_21.
Münevveroglu, C. & Gunduz, M. (2019) “Postoperative pain management for circumcision; Comparison of frequently used methods: Postoperative Pain Management for Circumcision,” Pakistan Journal of Medical Sciences, 36(2), pp. 91–95. Available at: https://doi.org/10.12669/pjms.36.2.505.
Nogueira, A.P.A. et al. (2024) “Efficacy of articaine anesthesia with needle-free/Comfort-in method and conventional needle injection in dental patients with irreversible pulpitis: a randomized clinical trial,” Clinical Oral Investigations, 28(3), p. 205. Available at: https://doi.org/10.1007/s00784-024-05582-w.
Perrot, S. et al. (2022) “The Patient-Centered Approach in Rheumatologic Painful Diseases: A Narrative Review,” Cureus [Preprint]. Available at: https://doi.org/10.7759/cureus.22244.
Qian, S. et al. (2025) “Articaine Needle - Free Anesthesia Vs Conventional Anesthesia in Root Canal Treatment of Irreversible Pulpitis in Permanent Teeth: A Prospective Study on Anesthetic Efficacy and Effects on Pain,” Journal of Pain Research, Volume 18, pp. 2115–2125. Available at: https://doi.org/10.2147/JPR.S514944.
Rahayuningrum, L.M. et al. (2020) “Bermain game edukasi Islami dapat menurunkan kecemasan anak usia 6-12 tahun pada waktu sirkumsisi,” Journals of Ners Community, 11(1), pp. 90–102.
Redho, A. et al. (2023) “Efektivitas Madu Trigona Sp terhadap Proses Penyembuhan Luka Post Sirkumsisi Tahap Proliferasi,” Jurnal Penelitian Perawat Profesional, 5(1), pp. 417–424. Available at: https://doi.org/10.37287/jppp.v5i1.1448.
Samsugito, I. et al. (2022) “Hipnoterapi Sebagai Pilihan Utama Manajemen Nyeri Pada Intraoperatif Sirkumsisi,” Jurnal Kreativitas Pengabdian Kepada Masyarakat (pkm), 5(2), pp. 436–441. Available at: https://doi.org/10.33024/jkpm.v5i2.4647.
Santoso, A.P.A. et al. (2022) “Kajian Yuridis Tindakan Circumsisi Oleh Perawat Pada Praktik Keperawatan Mandiri (studi Kabupaten Sidoarjo),” JISIP (Jurnal Ilmu Sosial dan Pendidikan), 6(2), pp. 3611–3625. Available at: https://doi.org/10.58258/jisip.v6i2.2816.
Saputro, H. & Efendy, M.A. (2021) “Differences in the Effectiveness of Hypnocircumcision and Free Needle Anesthesia on Children’s Pain Levels During the Circumcision Process,” STRADA Jurnal Ilmiah Kesehatan, 10(2), pp. 1431–1435. Available at: https://doi.org/10.30994/sjik.v10i2.577.
Sari, R.P. et al. (2022) “Edukasi Pencegahan Infeksi Saluran Kemih (Sirkumsisi) Pada Orang Tua Dan Anak Usia Sekolah Jamaah Masjid Darussalam Bengkuring Kota Samarinda,” Jurnal Kreativitas Pengabdian Kepada Masyarakat (PKM), 5(2), pp. 565–570. Available at: https://doi.org/10.33024/jkpm.v5i2.4729.
Selomo, P. (2022) “Kegiatan Sirkumsisi,” Pekan: Jurnal Pengabdian Kesehatan, 1(2). Available at: https://doi.org/10.33387/pekan.v1i2.5695.
Soegiharto, A.F.H. & Isrok, M. (2023) “Analisis patentability alat sunat sekali pakai pada pengembangan desain industri A00202202524,” TEKNOSAINS : Jurnal Sains, Teknologi dan Informatika, 10(2), pp. 220–227. Available at: https://doi.org/10.37373/tekno.v10i2.482.
Sundari, N.S. (2022) “Pengaruh Kualitas Pelayanan Terhadap Kepuasan Pasien Klinik Khitanan Paramedika Bandung (Studi Pada Klinik Khitan Paramedika),” Jurnal Pemasaran Kompetitif, 5(2), p. 136. Available at: https://doi.org/10.32493/jpkpk.v5i2.12493.
Thumma, N. et al. (2024) “A comprehensive review of current knowledge on penile squamous cell carcinoma,” Frontiers in Oncology, 14, p. 1375882. Available at: https://doi.org/10.3389/fonc.2024.1375882.
Vishwanathaiah, S. et al. (2024) “Comparative Evaluation of New Needleless Local Anesthetic System (INJEX) and Conventional Syringe Needle Technique during Pulpotomy Treatment: A Randomized Clinical Trial,” Children, 11(5), p. 514. Available at: https://doi.org/10.3390/children11050514.
Wang, X. et al. (2019) “Dorsal Penile Nerve Block via Perineal Approach, an Alternative to a Caudal Block for Pediatric Circumcision: A Randomized Controlled Trial,” BioMed Research International, 2019, pp. 1–7. Available at: https://doi.org/10.1155/2019/6875756.
Welan, R. (2023) “Sirkumsisi Sebagai Langkah Menjaga Kesehatan Reproduksi Pria,” Jurnal Altifani Penelitian dan Pengabdian kepada Masyarakat, 3(2), pp. 194–199. Available at: https://doi.org/10.59395/altifani.v3i2.357.
Yıldırım, S., Tokuç, M. & Aydın, M.N. (2020) “The effect of pre-anesthesia with a needle-free system versus topical anesthesia on injection pain of the inferior alveolar nerve block: a randomized clinical trial,” Clinical Oral Investigations, 24(12), pp. 4355–4361. Available at: https://doi.org/10.1007/s00784-020-03301-9.
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