Efficacy of EMLA® cream prior to dorsal penile nerve block for circumcision in children

Abstract

While circumcision may be performed solely with dorsal penile nerve block (DPNB), some painful steps in its use are skin needle penetration and infiltration of the anesthetic product. The objective of this study was to evaluate the efficacy of EMLA cream, prior to DPNB for circumcision in children. We conducted a prospective, randomized, double-blinded, placebo-controlled study with 42 children undergoing circumcision with DPNB alone, as an ambulatory procedure. Overall efficacy of EMLA cream (Group A) during needle penetration and infiltration was assessed using a visual analog scale, compared with a placebo cream (Group B). Patients were asked to orally report any pain during skin needle penetration and infiltration of anesthetic, and were graded from 1 to 4 according to intensity of pain, as 1) none, 2) slight, 3) moderate, or 4) severe. The child graded the global discomfort of the entire procedure using the visual analog scale. When assessing needle penetration, none from Group A suffered any pain, whereas all from Group B suffered at least mild pain. Considering infiltration of the anesthetic, all children suffered at least slight-to-moderate pain. Based on the children's visual analog scale scores, EMLA cream has no beneficial effect for penile block. Since the dorsal penile nerves are located under the Buck's fascia, topical anesthesia may not reach them and other techniques may be necessary to anesthetize them. We found that although EMLA cream is efficient as a topical anesthesia during needle penetration for DPNB, it has no beneficial effect during infiltration.