A prospective study was conducted to evaluate the efficacy of prior application of topical eutectic mixture of local anesthetics, EMLA, in alleviating the pain associated with infiltration local anesthetic (LA) for circumcision in children and to assess its impact on the outcome. A total of 173 children aged 3-13 years requiring circumcision were randomly assigned to have EMLA or placebo cream applied over the root of the penis 1 h before subcutaneous ring block. A blinded observer rated the pain response on a 10-point visual scale during needle insertion, injection of local anesthetic and circumcision. Children needing conversion to general anesthesia (GA) were counted as failures. A total of 89 and 82 boys were included in the EMLA group and placebo group, respectively. Significantly lower pain scores were recorded for needle puncture in the former group (P<0.001), whilst pain scores for injection and during circumcision were not statistically different between the two groups (P=0.037 and 0.138, respectively). A total of 88 out of the 89 boys pre-treated with EMLA completed the procedure, whereas seven boys in the placebo group necessitated conversion to GA (P=0.022). The converted cases had higher values for all pain scores and tended to be younger. Therefore, EMLA cream is a useful adjunct to LA for childhood circumcision because it effectively reduces the sharp pain induced by needle puncture. However, careful patient selection is required for a low conversion rate to GA.