Dorsal penile nerve block during newborn circumcision: underutilization of a proven technique?

Newborn circumcision is the most common surgical procedure in the United States. The technique for local anesthesia, dorsal penile nerve block (DPNB), was first described in 1978. Although multiple subsequent studies have reported that DPNB can relieve pain and stress during a newborn's circumcision without any additional morbidity, many practitioners do not employ this technique. A survey of randomly selected active members of the Oregon Academy of Family Physicians evaluated their perception and use of DPNB. One hundred members were contacted, and 96 responded. Only 36 percent of those physicians performing circumcision used DPNB in circumcisions. The most common reasons given for not employing DPNB were a lack of awareness of the technique (31 percent), believing that pain response in circumcision was not significant (29 percent), and concern about risks (27 percent). The median effectiveness rate reported by those using the block was 70 percent. The majority of respondents were interested in the results of the survey as well as in more information regarding the technique. We believe further educational efforts are indicated to increase awareness and use of DPNB in performing circumcisions in the newborn. Because there is significant variation in the effect achieved, some instruction in appropriate technique also is needed as part of this educational effort.