Here in Altoona PA the peds do the circs. I use EMLA cream, which helps with the initial hemostat application to the foreskin. Then when I release the adhesions with the probe, I use a probe dipped in a little xylocaine gel which provides a little bit of pain relief and lubricates the penile cap. The baby also gets to suck on some dextrose during the procedure. I use the Mogen technique which is very fast (about 30 second from first hemostat application to removal of the Mogen). This has worked reasonably well. The babies cry more when they're strapped to the circ board than during the procedure. Some people use either dorsal penile nerve block or circumferential block for circs with good success also. I think that anesthesia should be used for circs--it is a painful procedure for the infant and we should do what we can to minimize that. I agree with the AAP's recommendations for use of some sort of pain relief during the circ procedure. Pediatricians should either be doing the circs themselves and using anesthesia or try to get their colleagues in OB/Gyn to use anesthesia for the procedure. Linda Shaw MD FAAP Altoona PA