Introduction
Adult circumcisions can be performed under regional anaesthesia but often require an anaesthetist and may be ineffective. The use of topical 5% eutectic mixture of local anaesthetic (EMLA) cream in paediatric circumcision is well described but sparsely, in adults. We evaluated the effectiveness and tolerability of our experience using EMLA cream in adult circumcision.
Methods
A single surgeons’ experience performing adult circumcision, using EMLA cream was evaluated. During the 2-year period, commencing in November 2022, 115 men underwent a circumcision, 82 men agreed to undergo the surgery using EMLA cream. Exclusion criteria included men requesting a general anaesthetic or needle phobic. On the day of surgery, EMLA cream was inserted into the prepuce and applied to the outer prepuce. Surgery was performed 40 - 60min later. Demographic and perioperative data was evaluated including a telephone review at 6 weeks.
Results
The median age was 36 years (range 18-86). Mean operative time was 15min (range 12-21). No additional LA was required. All men tolerated the procedure and described it as pain-free. No intraoperative complications but one patient suffered a wound infection.
Conclusions
Our results show that men willing to undergo a circumcision using EMLA cream, it is safe and 100% effective. Gyftopoulos1 reported 20.5% effectiveness but EMLA application was for only 20-30 min. Dorsal penile block requires the use of a needle and is operator-dependent and not always effective (2).
References
1. Gyftopoulos. Urol Ann. 2012 Sep;4(3):145-9
2. Flores et al. Am J Emerg Med. 2015 Jun;33(6):863.e3-5
Authors
Jack Corkerry
Hull University Teaching Hospitals, Hull, United Kingdom
Deepak Sharma
Sandwell and West Birmingham University Hospitals, Birmingham, United Kingdom
Sanjeev Pathak
Kingsbridge Hospital, Belfast, United Kingdom