Use of Emla prior to circumcision

There are insufficient data to support the use of Emla cream for circumcision in newborn infants at this time. There are no studies that adequately address safety or efficacy. Before efficacy studies can be evaluated, pharmacodynamic studies need to be completed. These studies are in progress and are closed (personal communication, Vivian Broach BSPharm, Astra Pharmaceutical Product Information Service, Astra Pharmaceutical, Westborough, MA, June 8, 1995). Subsequent studies should be performed within the first 72 hours of birth and assess the following parameters: (1) serum concentrations of metHb, lidocaine, and prilocaine and its metabolites from time zero to at least 24 hours after application of the cream; (2) application time and dose applied should be varied to assess differences in absorption, as well as onset and duration of analgesia; (3) application technique could be varied to assess the depth of analgesia, that is, application to the inner and outer surface of the prepuce versus the outer surface only. Until these studies are completed, routine use of Emla cream for local anesthesia during circumcision cannot be recommended.