Topical anaesthesia in neonatal circumcision: a study of 208 consecutive cases

To assess the suitability and effectiveness of EMLA cream (a eutectic mixture of lignocaine and prilocaine) as a topical anaesthetic for routine neonatal circumcision.

A clinical trial of EMLA cream was conducted on 208 consecutive routine neonatal circumcisions. All circumcisions were performed by the Plastibell technique with prior use of EMLA anaesthetic cream. Results were obtained by intra-operative observation and follow-up questionnaire answered by parents.

There was a marked decrease in crying during the procedure. In infants under the age of 7 months, 99.0% fed immediately, 96.0% settled rapidly and remained settled, 96.5% had no disturbance of sleep pattern, 92.5% had little or no pain and 96.0% had no pain or difficulty when urinating. None required stronger analgesia than paracetamol. Infants over the age of 7 months had more difficulty settling; however, their discomfort was no different from that seen in infants of similar age who were circumcised using general anaesthesia. There were no 'serious' complications and only 3.5% had minor complications. There were no side effects or complications attributable to the EMLA cream.

EMLA anaesthetic cream, properly applied, is a safe and effective method of anaesthesia for circumcision of neonates to 7 months of age. It reduces or eliminates pain, restlessness, agitation and interference with parent bonding. The common practice (in Australia) of suggesting that parents postpone circumcision until the child is suitable for general anaesthesia should be seriously questioned.