UroToday - One of the primary concerns parents have with newborn circumcisions is pain control. Local anesthesia has been proven beneficial for post circumcision pain relief. However, this might not always be the clinical practice. This study by Yawman et al assessed the current training practices regarding the provision of effective analgesia for routine newborn circumcision.

All family practice (FP), obstetric and gynecologic (OB/GYN), and pediatric (PED) residency program directors in the United States received a mailed survey in 2003 (N = 940). Survey responses were received from 86% (811/940) of the programs (FP 88%, OB/GYN 82%, and PED 87%). Eighty-two percent (669/811) of all programs surveyed taught circumcision (FP 95%, OB/GYN 89%, and PED 49%). Of programs that taught circumcision, 97% (648/669) taught the administration of an anesthetic, either locally or topically. When compared to a report from 1998, this proportion is significantly higher (71%, 374/527; P < .001). However, of these same programs that taught circumcision, the anesthetic techniques were used in only 84% of the cases.

The study concluded that the percentage of training programs that teach effective analgesia for neonatal circumcision increased dramatically since the time of the previous data collection. Despite this improvement in teaching practices, it seems that training programs may not consistently use effective analgesia for neonatal circumcision. Was there a reason why a local anesthetic was not implemented? Was there a medical or parental concern? These are questions one must ask in order to determine if the use of local anesthesia was contraindicated or just not part of that practice. Local anesthesia, especially topical, adds little risk and should be considered for all circumcisions, if not standard of care in my opinion.

Pain Relief for Neonatal Circumcision: A Follow-up of Residency Training Practices
Ambulatory Pediatrics 6(4): 210-214, July 2006.
Daniel Yawman MD, MPH, Cynthia R. Howard MD, MPH, Peggy Auinger MS, Lynn C. Garfunkel MD, Marjorie Allan BS and Michael Weitzman MD.
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