EFFICACY OF EMLA(R) CREAM PRIOR TO DORSAL PENILE NERVE BLOCK FOR CIRCUMCISION IN CHILDREN

Background: While circumcision map be performed solely with dorsal pen ile 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(R) cream, prior to DPNB for circumcision in children. Methods: We conducted a prospective , randomized, double-blinded, placebo-controlled study with 42 childre n undergoing circumcision with DPNB alone, as an ambulatory procedure. Overall efficacy of EMLA(R) cream (Group A) during needle penetration and infiltration was assessed using a visual analog scale, compared w ith a placebo cream (Group B). Patients were asked to orally report an y 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 di scomfort of the entire procedure using the visual analog scale. Result s: When assessing needle penetration, none from Group A suffered any p ain, 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(R) cream has no beneficial effect for penile block. Conclusion: Since the dorsal penile nerves are located under the Buck's fascia, to pical anesthesia may not reach them and other techniques may be necess ary to anesthetize them. We found that although EMLA(R) cream is effic ient as a topical anesthesia during needle penetration for DPNB, it ha s no beneficial effect during infiltration.