EMLA Cream with Circs

Specialties Ob/Gyn

Published

Specializes in L&D, Nursery, NICU & Post Partum.

Hi,

Does anyone have a policy for EMLA cream with circumcisions? I hear that Joint Commission does not accept sweeties as a form of pain control. They want to see EMLA cream or a block used. Some of our Doctors do not do the block rather Hurricaine Spray.

Much Appreciated!

D

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Specializes in LPN, Peds, Public Health.

We always used a block, never a cream.

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Specializes in multispecialty ICU, SICU including CV.

I'm not a pedi nurse but I sat in on my son's circ (outpatient at 1 mo, in a clinic). He got a local (I think lidocaine). He cried more from being tied down to the board than the procedure itself, for which I was thankful.

I would not have been happy with EMLA or hurricane spray as a parent. That stuff is topical -- doesn't go very deep at all. I doubt it would have been sufficient pain coverage for the procedure being done. It's also my understanding that you have to let EMLA sit there for 20-30 minutes for full effect. He also got some relief after he went home for a few hours with the local.

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

EMLA is great, along with the suc and I am for blocks as well.

I had someone go under GA for the other day for a circ. NOT good, in my eyes....

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Specializes in Mom/Baby.

I find this funny, because I just saw my first circ with EMLA two days ago. I've never seen that before and I was like what the heck!! I've only seen it done with lidocaine before then.

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Specializes in multispecialty ICU, SICU including CV.
EMLA is great, along with the suc and I am for blocks as well.

I had someone go under GA for the other day for a circ. NOT good, in my eyes....

An older kid or adult? That seems excessive to me too, regardless.

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Specializes in NICU, PICU, educator.

We use EMLA, but the kids have to be a certain gestation and weight, I believe 35 weeks and at least 1800grams. The kids are much happier with EMLA..no pokes. It does have to be put on 20-30 minutes before and can only stay on for 45 minutes tops. We always give Tylenol before the procedure (actually right after we strap them down...the love the taste of it) and then every 6 hours for 24 hours after. Otherwise they get a block. Same Tylenol regime. Sucrose isn't for surgical pain. We don't use the spray..I think there are limitations with that for neonates...we have only used it on kids that need and I/D of an abcesses, but there are precautions we had to take like making sure it was only on the small area we needed, no splatter.

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The vast majority of our docs only use sweet ease . . . yeah, not happy about that but it's not my decision. I do have to say I assisted on a circ the other day where the doc did use lidocaine and I wasn't overly impressed . . . it took forever doing the injections and there were so many sticks. I will say for the life of me IDK why we can't give these kids tylenol at least. :uhoh3:

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

We use Sweetease, but not JUST Sweetease. Almost exclusively, a penile nerve block with Lidocaine. Sweetease on a pacifier to help calm the baby.

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
An older kid or adult? That seems excessive to me too, regardless.

A NEWBORN. I was floored. Couldn't believe mom would GA her kid just for the circ.

JUST a circ, a normal, healthy, no urethra issues baby...under GENERAL.

I was a little peeved.

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Specializes in nursery, L and D.

If I ever grew a winky and someone wanted to cut it I'd want GA too. Ok, so maybe not. I've had D and Cs with nothing and it wasn't that bad. At the small hospital I worked at the majority did just sweetease. No one did blocks at all. One doc did use EMLA. We would put it in a bottle nipple and apply 45min before procedure. It was better than nothing.

This whole experiance is why the little one growing in my belly will remain intact. My other boys were circed because I was young and didn't really think about it and it was just something you did. I don't bash or blame anyone for doing it (parents) but I do blame the peds at that hospital (peds did it there, not OB) for not using something other than sugar water as pain control.

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I wonder if the doctor would let someone cut on his winky if he only had sweatease for painkiller?

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