Study objective: To determine attitudes regarding routine use of analgesia for newborn circumcision among primary care physicians in southwestern Ontario.
Design: Questionnaire survey conducted among all family physicians and pediatricians belonging to the London Academy of Medicine. The majority of pediatric primary care in this region is provided by family physicians.
Setting: Metropolitan center in Southwestern Ontario.
Respondents: A questionnaire was mailed to 279 physicians; 171 (61%) responded.
Results: Seventy-four (43%) respondents performed circumcisions. Among physicians performing circumcisions, a minority (17; 24%) used any form of analgesia. The most commonly used analgesic (14; 20%) was oral ethanol. Only 3 (4%) physicians used dorsal penile nerve block. The most common reasons listed for not employing analgesia were lack of familiarity with analgesia use among neonates (56%), lack of familiarity with the technique of dorsal penile block (50%), and concern over adverse effects of analgesic drugs (49%) and regional analgesia (44%). Only a small minority of physicians (7; 12%) responded that they believe that neonates do not feel pain, and 20 (35%) believe that neonates do not remember pain.
Conclusions: Despite evidence that neonates perceive pain and that there is a physiologic stress response to circumcision which can be reduced if analgesia is employed, the vast majority of physicians performing newborn circumcisions either do not employ analgesics or employ analgesics of questionable efficacy. Lack of familiarity with the use of analgesics among neonates and with dorsal penile block in particular are the most common reasons cited for lack of analgesic use. Educational efforts and research into less invasive techniques of analgesia for newborn circumcision are urgently required.