Changing Attitudes and Practices Regarding Local Analgesia for Newborn Circumcision

Abstract

Study Objective. To change physician attitudes and practices regarding the routine use of local and regional anesthesia for newborn circumcision.

Design. Interventional study, followed by an audit of physician practice over a 1-month period, 1 year following interventions.

Setting. The newborn nurseries of the Women's Pavilion, Royal Alexandra Hospital, Edmonton.

Interventions. A broad range of awareness and educational programs were directed at physicians who perform newborn circumcisions, including posters, newsletters, presentations at grand rounds, video recordings, and practical hands-on demonstration of the techniques of local anesthesia to the prepuce and dorsal penile nerve block.

Results. Only one physician was using local analgesia for newborn circumcision prior to the introduction of the educational program. The audit, performed 12 months later, documented 46 circumcisions performed by 22 physicians, each performing between 1 and 6 circumcisions (median = 1). Sixteen of the 22 physicians (73%) used either local anesthesia to the prepuce (19 cases) or dorsal penile nerve block (13 cases) during circumcisions. Thus, local analgesia was used in 66% (32/48) of all circumcisions. Six physicians, performing 16 circumcisions, do not use any form of analgesia.

Conclusions. This simple educational program has been associated with a remarkable change in attitudes and practice regarding local analgesia for neonatal circumcision. Our ideal objective, which we hope to achieve through repeated education and practical demonstrations of the techniques to interested physicians, is that all newborn circumcisions are performed under local or regional anesthesia in our institution.