Changing attitudes and practices regarding local analgesia for newborn circumcision.
OBJECTIVE
To change physician attitudes and practices regarding the routine use of local and regional anesthesia for newborn circumcision.


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


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


METHODS
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.
Department of Newborn Medicine, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
C A
CA
Ryan
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Finer
D000416:Alberta; D000698:Analgesia / Q000379:methods* / Q000706:statistics & numerical data; D000765:Anesthesia, Conduction / Q000379:methods / Q000706:statistics & numerical data; D000772:Anesthesia, Local / Q000379:methods / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D002944:Circumcision, Male / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007318:Inservice Training; D008297:Male; D008485:Medical Audit / Q000706:statistics & numerical data; D009741:Nursing Staff, Hospital / Q000523:psychology / Q000706:statistics & numerical data; D010820:Physicians / Q000523:psychology / Q000706:statistics & numerical data; D013997:Time Factors