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Local anesthesia for neonatal circumcisions: are family practice residents likely to use it?

Dorsal penile nerve block with lidocaine (DPNB) is a local anesthetic technique for neonatal circumcision which is both effective and consistent with ethical concerns for infant welfare. As such, it should be included in training programs that prepare residents to care for newborns. To assess the current level of DPNB use by residents in a family practice training program and to identify attitudes and other factors that relate to use, a survey was sent to 127 residents in the Department of Family Practice and Community Health, University of Minnesota. Of the 101 respondents, 55% had used DPNB, and 17% could be characterized as high users, employing the technique for over one half of the circumcisions they performed. Residents with comprehensive understanding of the newborn's capacity to feel pain were more likely to be using DPNB than their less well-informed counterparts. Four factors were identified as predicting use: cooperation of nursery staff for the procedure, accessibility of instruction in PNB technique, belief that PNB is effective in reducing infant pain, and likelihood of parents giving consent for PNB. These results suggest strategies which may be implemented by family practice educators who wish to promote the principles and techniques of DPNB.