A Clinical Comparison of EMLA Cream and Ethyl Chloride Spray Application for Pain Relief of Forehead Botulinum Toxin Injection

Irkoren, Saime; Ozkan, Heval Selman; Karaca, Hüray

doi:10.1097/sap.0000000000000121

Cited by 27 publications

(14 citation statements)

References 8 publications

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“…Skin cooling (with ethylchloride spray, dry cold, or ice) or local application of anesthetic cream decreases pain associated with limb or facial botulinum injections ( 81 – 83 ). As such, they may be beneficial in patients for the treatment of CD too, although no specific studies were found.…”

Section: Resultsmentioning

confidence: 99%

Clinical Practice: Evidence-Based Recommendations for the Treatment of Cervical Dystonia with Botulinum Toxin

et al. 2017

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Cervical dystonia (CD) is the most frequent form of focal dystonia. Symptoms often result in pain and functional disability. Local injections of botulinum neurotoxin are currently the treatment of choice for CD. Although this treatment has proven effective and is widely applied worldwide, many issues still remain open in the clinical practice. We performed a systematic review of the literature on botulinum toxin treatment for CD based on a question-oriented approach, with the aim to provide practical recommendations for the treating clinicians. Key questions from the clinical practice were explored. Results suggest that while the beneficial effect of botulinum toxin treatment on different aspects of CD is well established, robust evidence is still missing concerning some practical aspects, such as dose equivalence between different formulations, optimal treatment intervals, treatment approaches, and the use of supportive techniques including electromyography or ultrasounds. Established strategies to prevent or manage common side effects (including excessive muscle weakness, pain at injection site, dysphagia) and potential contraindications to this treatment (pregnancy and lactation, use of anticoagulants, neurological comorbidities) should also be further explored.

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Section: Resultsmentioning

confidence: 99%

Clinical Practice: Evidence-Based Recommendations for the Treatment of Cervical Dystonia with Botulinum Toxin

et al. 2017

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“…For example, France et al 16 showed that pain from arterial punctures was not affected using ethyl chloride coolant vapor. But Irkoren et al 17 showed that skin cooling with ethyl chloride spray significantly decreases the pain associated during forehead BTX injections. Moreover, crushed ice packs provide more effective cryoanalgesia than cold gel packs or cold water immersion.…”

Section: Discussionmentioning

confidence: 99%

A comparative trial of ice application versus EMLA cream in alleviation of pain during botulinum toxin injections for palmar hyperhidrosis

Alsantali¹

2018

CCID

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BackgroundBotulinum toxin is a safe and effective therapy for palmar hyperhidrosis, but the associated pain from injections limits the usefulness of this method of treatment.PurposeTo evaluate the efficacy of Eutectic Mixture of Local Anesthetics (EMLA) cream versus ice application in alleviation of pain during botulinum toxin injections for palmar hyperhidrosis.MethodsIn this prospective study, 23 patients underwent palm Botox injections to treat their excessive sweating. In each patient, EMLA cream was applied to one palm and ice was applied directly before the injections in the other palm. Pain was evaluated using a Visual Analog Scale.ResultsStatistically, there was a significant difference in pain control between EMLA cream group and ice application group (p<0.05). The average pain score on the hands where EMLA cream was applied was 8.9 (SD=0.81), whereas it was 4.8 (±0.9) in the ice group.ConclusionIn this study, the successful use of ice application in reducing pain by 40% in comparison to EMLA cream during Botox toxin injection for palmar hyperhidrosis is demonstrated.

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“…Ethyl chloride spray is a cryoanaesthetic agent that fulfils many properties of an ideal topical anaesthetic: its onset is immediate, it is non‐invasive, it is effective, its offset is rapid and, in addition to these, it is low cost. Ethyl chloride spray is readily available in most hospital anaesthesia departments and has been demonstrated to be valuable as a topical anaesthetic in a range of paediatric and adult environments . Therefore it seemed appropriate to apply it in an attempt to minimise the discomfort from finger prick blood testing.…”

Section: Discussionmentioning

confidence: 99%

Anomalous point‐of‐care ketone reading following use of ethyl chloride spray as a topical anaesthetic during the treatment of a teenager with DKA

2018

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We present the case of an anomalous ketone reading in a 16‐year‐old female patient with type 1 diabetes following the administration of ethyl chloride spray as a topical anaesthetic. The patient presented in diabetic ketoacidosis (DKA) and was agitated, distressed and combative. Assistance was sought in the ongoing management of the patient from the on‐call anaesthetic and intensive care team. The choice was made to use ethyl chloride spray as a topical anaesthetic. This was done in order to decrease the discomfort of capillary blood tests in an attempt to ameliorate the patient's agitation and distress. It was noted that when this spray was applied prior to point‐of‐care ketone concentration testing, a ketone reading out of context of the clinical picture was obtained. There is no caution against using ethyl chloride spray in the product literature for the ketone meter used in our hospital, but there is guidance about cleaning the hands and test site with soap and warm water. This was briefly investigated by this team and anomalous ketone concentrations were reproduced in a healthy volunteer who had ketone levels checked pre‐ and post‐application of ethyl chloride spray. There is no current published literature regarding abnormal ketone results following application of topical anaesthetic agents. Therefore, based on this experience, caution would be advised in using topical anaesthetic agents prior to capillary blood sampling and emphasis placed on strict adherence to the manufacturer's guidance of cleansing the hands and test site with warm water and soap prior to capillary sampling. Copyright © 2018 John Wiley & Sons.

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A Clinical Comparison of EMLA Cream and Ethyl Chloride Spray Application for Pain Relief of Forehead Botulinum Toxin Injection

Abstract: Skin cooling with ethyl chloride spray significantly decreases the pain associated during forehead botulinum toxin injections.

Cited by 27 publications

References 8 publications

Clinical Practice: Evidence-Based Recommendations for the Treatment of Cervical Dystonia with Botulinum Toxin

Clinical Practice: Evidence-Based Recommendations for the Treatment of Cervical Dystonia with Botulinum Toxin

A comparative trial of ice application versus EMLA cream in alleviation of pain during botulinum toxin injections for palmar hyperhidrosis

Anomalous point‐of‐care ketone reading following use of ethyl chloride spray as a topical anaesthetic during the treatment of a teenager with DKA

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