Kate, the pediatric urologists at your hospital either don't know how to do a proper nerve block, or the nerve block is not as effective in older babies (which suggests doing it in the first three days of life is the better option then). I just did a couple of circs this AM that the babies SLEPT THROUGH. One did not even cry during the injection for the nerve block. Most of the babies I circumcise sleep through the procedure.
I perform circumcisions (would rather not) at family request after discussing pros and cons (emphasizing cons).
Some boys cry even after numbing the heck out of them.
I use dextrose water and dorsal nerve block, and the majority of the kids scream as we are setting up, then as the lidocaine kicks in and the start sucking they fall asleep.
I have had to stop one circ after a minor abnormality was found after the dorsal slit was cut, and had one ooze a bit and needed adsorbable hemostat.
do as you wish--I also have had a small number of boys school age who had painful phimosis and two request circumcision due to recurrent phimosis. They needed the anethesia for their circumcsions.
Also type of circumcision is based on the provider and how they were trained. If someone asked me to do a plastibell circ I would tell them no, I have never done one. Or I would ask another provider who has done plastibell before to perform the circ.