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PEDIATRIC ANESTHESIA

EMLA^® Cream Versus Dorsal Penile Nerve Block for Postcircumcision Analgesia in Children

W.Y. Choi, MB, BS^*, M.G. Irwin, MB, ChB, FRCA, FHKAM, T.W.C. Hui, MB, BS, FANZCA, FHKAM, H.H. Lim, MB, BS, FHKAM, and K.L. Chan, MB, BS, FRCS, FHKAM

*Department of Anaesthesia and Intensive Care, Pamela Youde Nethersole Eastern Hospital, Chai Wan; and Department of Anaesthesiology and Surgery, Queen Mary Hospital, Hong Kong

Address correspondence and reprint requests to W.Y. Choi, MB, BS, Department of Anaesthesia and Intensive Care, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong. Address e-mail to reginachoi{at}hotmail.com

We conducted a prospective, randomized, double-blinded trial comparing preoperative application of EMLA^® cream and sodium chloride solution dorsal penile block (n = 31) with placebo cream and bupivacaine dorsal penile nerve block (n = 32) for postcircumcision analgesia. Pain was assessed using modified Children’s Hospital of Eastern Ontario Pain Scale and the duration of block by the time to requirement of first dose of postoperative analgesic. There was no difference in Children’s Hospital of Eastern Ontario Pain Scale between the two groups, but bupivacaine dorsal penile nerve block resulted in longer analgesia (P = 0.003). There were no local or systemic complications related to either technique, and there was a very small incidence of vomiting. We conclude that preoperative application of EMLA^® cream is an effective and simple method to produce postcircumcision analgesia with a very small incidence of adverse effects.

IMPLICATIONS: This study shows that topical application of EMLA^® cream before circumcision is simple and effective with few side effects.

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