This study was designed to test the effi-cacy of topical anesthetic EMLA in diminishing the pain from circumcision in the newborn male infant. Although we believe that unanesthetized circumcision may be harmful for newborns, we used a control placebo group, as the current practice at our institution is not to give anes-thesia or analgesia for the procedure. The newborn was the placed in a supine position on a circumcision board with arms and legs restrained just below the shoulders and at the groin with canvas straps for the procedure. The range of procedure time was 6 to 40 minutes. Newborns in this study who had an application of EMLA 45 to 60 minutes prior to circumcision showed less increase in heart rate, less decrease in oxygen saturation, less facial actions, and less crying associated with pain than newborns who had received placebo cream.
Neonatal circumcision is a painful surgical procedure often per-formed without analgesia.
One gram of lidocaine-prilocaine or placebo cream was applied to the penis under an occlusive dressing for 60 to 80 minutes before circumcision. Behavioral and physiologic responses were recorded during the procedure. A total of 68 and 59 neonates were included in the safety and efficacy analyses, respectively. Demographic characteristics such as gestational age and birth weight did not differ between the lidocaine-prilocaine and placebo groups. During circumcision, the neonates in the lidocaine-prilocaine group had less facial activity, spent less time crying, and had smaller increases in heart rate than the neonates in the placebo group.