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Case Reports
. 2013 Feb;9(1):e86-90.
doi: 10.1016/j.jpurol.2012.09.013. Epub 2012 Oct 24.

Loss of anatomical landmarks with eutectic mixture of local anesthetic cream for neonatal male circumcision

Rebeca M Plank  1 , David W Kubiak, Rasak Bamidele Abdullahi, Nnamdi Ndubuka, Maggie M Nkgau, Fredrick Dapaah-Siakwan, Kathleen M Powis, Shahin Lockman
Affiliations
Case Reports

Loss of anatomical landmarks with eutectic mixture of local anesthetic cream for neonatal male circumcision

Rebeca M Plank et al. J Pediatr Urol. 2013 Feb.

Abstract

We report two cases of newborns who developed marked local edema after application of a eutectic mixture of local anesthetic (EMLA) topical anesthetic cream for neonatal male circumcision (NMC). Although local edema and erythema are known potential side effects of EMLA cream, a common anesthetic used for NMC, the loss of landmarks precluding safe NMC has not previously been reported, and is described here. Although we cannot recommend an alternate local anesthetic for neonates with this reaction to EMLA, based on a review of the published data we think that serious systemic adverse events related to EMLA are extremely rare.

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Conflict of interest statement

Conflict of interest statement

None of the authors has any financial or personal relationships with other people or organisations that could inappropriately influence his or her work.

Figures

Figure 1
Figure 1
Infant 1: a) about 2 hours after application of EMLA, with localized bullous edema of distal foreskin with obliteration of normal anatomical landmarks; b) ventral aspect of penis showing spread of edema along median raphe. Note obliteration of the perimeter of the coronal sulcus that would usually be apparent beneath the foreskin: c) Follow-up 96 hours later reveals normal uncircumcised penis and discernable coronal sulcus.
Figure 2
Figure 2
Infant 2: a) about 2 hours after application of EMLA, with localized bullous edema of distal foreskin with obliteration of normal anatomical landmarks: b) Follow-up 24 hours later reveals normal uncircumcised penis.
Figure 3
Figure 3
Typical reaction to EMLA with mild edema of the distal foreskin.
See this image and copyright information in PMC

References

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