Depth and Duration of Skin Analgesia to Needle Insertion After Topical Application of Emla Cream

Bjerring, Peter; Arendt-Nielsen, Lars

doi:10.1093/bja/64.2.173

Cited by 281 publications

(139 citation statements)

References 8 publications

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“…Previous studies indicate that various contributory factors can affect pain intensity during injection, such as velocity, 39,40 angle of insertion, 39 depth of injection, 41 needle diameter, 39,42 needle tip bluntness, 43 regional variation, 44 and activated nociceptor density. 40 Jorgensen 42 suggested that thinner needles induce less injection pain, but another study that used an automated and controlled needle insertion device found that although needle diameter could affect pain intensity when the skin is repeatedly needled, pain intensity for a single cutaneous needle insertion is not significantly related to needle length or diameter.…”

Section: Discussionmentioning

confidence: 99%

“…40 Jorgensen 42 suggested that thinner needles induce less injection pain, but another study that used an automated and controlled needle insertion device found that although needle diameter could affect pain intensity when the skin is repeatedly needled, pain intensity for a single cutaneous needle insertion is not significantly related to needle length or diameter. 40 Unlike previous studies, [39][40][41][42][43][44] which investigated the intensity of pain caused by skin damage by single or repeated subcutaneous or intradermal injections, trigger point injections may have different contributing factors because repeated injections to muscle, along with single skin insertion, are the main causes of pain. We considered that LTR originating from muscle and fascia might also contribute to pain during trigger point injection.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of 3 Needle Sizes for Trigger Point Injection in Myofascial Pain Syndrome of Upper- and Middle-Trapezius Muscle: A Randomized Controlled Trial

Rah

Sheen

et al. 2009

Archives of Physical Medicine and Rehabilitation

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Objectives: To investigate (1) the relation between needle diameter and treatment efficacy of myofascial pain syndrome and (2) the relation between needle diameter and pain intensity during injection.Design: Randomized controlled trial. Setting: University-affiliated tertiary-care hospital. Participants: Volunteers (Nϭ77) with myofascial pain syndrome affecting upper-and middle-trapezius muscles with at least 3 months' duration of pain.Intervention: Participants were randomly assigned to receive trigger point injections on 1 side of the trapezius with a 21-, 23-, or 25-gauge needle. After a 1-time injection, participants were followed up for 14 days. Participants and the assessor were blinded for group assignment.Main Outcome Measures: Treatment efficacy was measured with the visual analog scale (VAS; at pretreatment, and posttreatment on days 1, 4, 7, 14) for neck and upper-back pain, the Neck Disability Index (NDI; at pretreatment, and posttreatment on days 7, 14), and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36, at pretreatment and posttreatment on days 7, 14) for health-related quality of life. Pain intensity during injection was evaluated immediately after injection with VAS.Results: VAS scores for posttreatment on days 4, 7, and 14 decreased significantly compared with pretreatment scores in all groups; NDI scores on days 7 and 14 decreased significantly compared with pretreatment scores in all groups; SF-36 scores on days 7 and 14 decreased significantly compared with pretreatment scores in the 21-and 23-gauge needle groups; and SF-36 score on day 14 showed significant difference between the 21-and 25-gauge needle groups. For pain intensity during injection, VAS scores indicated no significant difference between the 3 groups. Conclusions:No difference between the needle types was observed in terms of VAS or NDI, or in terms of pain intensity felt by patients during injection. In terms of SF-36 scores, injections with 21-or 23-gauge needles were found to be more effective. However, a well-controlled investigation is needed to explore the effect of needle thickness on health-related quality of life.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of 3 Needle Sizes for Trigger Point Injection in Myofascial Pain Syndrome of Upper- and Middle-Trapezius Muscle: A Randomized Controlled Trial

Rah

Sheen

et al. 2009

Archives of Physical Medicine and Rehabilitation

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“…10 The maximal depth of analgesia (5 mm) has been observed for 30 min after a 90 min application, and during the 60 min period after a 120 min application. 14 Since EMLA has been reported to provide effective anaesthesia for venepuncture, subcutaneous injection, and even split skin grafting, 10,15 we did not think a controlled trial comparing the efficacy of the EMLA cream against a control group was necessary in this study. Instead, we wanted to ascertain if the use of alkalinized LA solution is necessary in the presence of EMLA.…”

Section: Discussionmentioning

confidence: 99%

Bone marrow harvesting using EMLA (eutectic mixture of local anaesthetics) cream, local anaesthesia and patient-controlled analgesia with alfentanil

Sim

1999

Bone Marrow Transplant

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Summary:Bone marrow harvesting (BMH) was performed on 40 consecutive allogeneic or autologous donors using EMLA (eutectic mixture of local anaesthetics), local anaesthesia (LA) and patient-controlled analgesia with alfentanil (PCA-A). The effect of alkalinizing the LA solution on reducing pain during LA infiltration in the presence of EMLA was also investigated. EMLA 10 g with occlusive dressing was applied to the harvest sites at least 60 min before BMH. The PCA device was programmed to deliver an intravenous loading dose of 15 g/kg alfentanil, followed by a background alfentanil infusion of 0.05 g/kg/min. Demand dose was 4 g/kg and lockout time was 3 min. Donors were randomized to receive either alkalinized (n = 19) or non-alkalinized (n = 21) LA solution (lignocaine 1% with 1:100 000 adrenaline). While post-operative nausea and vomiting were the only side-effects, all donors in both groups reported satisfactory pain scores during LA infiltration and satisfactory overall intra-operative comfort scores. They completed BMH using either regimen successfully, found this technique acceptable and would recommend this form of anaesthesia to others. Alkalinizing the LA solution did not significantly improve the pain scores during LA infiltration in the presence of EMLA. In conclusion, BMH can be performed safely using EMLA, LA and PCA-A without major complications.

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“…[1][2][3] Eutectic mixture of local analgesics has also been used to alleviate cutaneous pain in children and adults. 4 However, for optimal analgesic effects, the correct amount of the drug must be applied and the skin should be properly dressed for an effective absorption. 4 In this regard, lidocaine tape has advantages and is frequently used because of easier application.…”

Section: Skin Analgesia With Lidocaine Tape Prior To Epidural Blockadementioning

confidence: 99%

“…4 However, for optimal analgesic effects, the correct amount of the drug must be applied and the skin should be properly dressed for an effective absorption. 4 In this regard, lidocaine tape has advantages and is frequently used because of easier application. However, although the tape is clinically useful, elevation of the pain threshold as measured by depth of needle insertion and the optimal duration of application remain unclear.…”

mentioning

confidence: 99%

Skin analgesia with lidocaine tape prior to epidural blockade

Sobue¹,

Tsuda²,

Yumoto³

et al. 2003

Can J Anesth/J Can Anesth

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To the Editor: Racemic bupivacaine, when injected intravascularly, is associated with serious cardiac complications 1 such as ventricular fibrillation resistant to successful resuscitation. No such serious outcome was reported hitherto with levobupivacaine. The present case reports the accidental intravascular injection of a combination of levobupivacaine and lidocaine used for axillary brachial plexus blockade.A 35-yr-old patient was admitted to the hospital for orthopedic surgery. Following premedication with midazolam (4 mg) and placement of all monitors, he received an axillary plexus block by the transarterial approach using a mixture of lidocaine 2% (20 mL) and levobupivacaine 0.75% (20 mL). Twenty-five millilitres of the local anesthetic mixture was deposited posterior and 15 mL anterior to the axillary artery. Briefly after deposition and without showing signs of light central nervous system (CNS) toxicity (lightheadedness, tinnitus, metallic taste), the patient exhibited three interrupted episodes of tonic-clonic seizures, each lasting for about three seconds and eventually resulting in unconsciousness. The patient's heart rate (HR) showed a sinus tachycardia of 160 beats·min -1 , the blood pressure (BP) increased to 180/120 mmHg and the SPO 2 decreased to 40% within one minute. For seizure control, the patient was given 5 mg of midazolam and 100 mg of propofol iv. Following mask ventilation with 100% oxygen, he was intubated and brought to the postanesthesia care unit. His vital signs stabilized within 30 min (BP 103/74, HR 84, SPO 2 97%) without further pharmacologic support and he was extubated. Two hours after extubation, he was alert and oriented and discharged to home. The patient did not show signs of sensory and motor blockade.A recent case report of an accidental intravascular injection following epidural anesthesia with 19 mL of levobupivacaine 0.75% resulted in only minor CNS side effects (drowsiness, slurred speech) and, most importantly, no cardiac sequelae. 2 Plasma levels were not taken until 14 min after epidural injection, still they revealed a toxic range of levobupivaciane that, most likely, was substantially higher immediately after its intravascular administration. Though the severity of side effects remains unknown had racemic bupivacaine been administered in this patient, previous reports hint at a more serious outcome after racemic bupivacaine 0.75%. 1 Similarly, no cardiac effects other than a sinus tachycardia occurred in this young and otherwise healthy patient.It appears that levobupivacaine is a safer drug than racemic bupivacaine, still vigilance and the laws of regional anesthesia (slow and intermittent injections, frequent aspirations) need to be practiced to take advantage of levobupivacaine's wider margin of safety. Skin analgesia with lidocaine tape prior to epidural blockadeTo the Editor: Lidocaine tape (Penles®, Japan Lederle, Tokyo, Japan) is a self-adhesive poultice for local anesthesia containing 18 mg of lidocaine at a concentration of 60% in a 30.5 × 50.0 mm po...

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Depth and Duration of Skin Analgesia to Needle Insertion After Topical Application of Emla Cream

Cited by 281 publications

References 8 publications

Comparison of 3 Needle Sizes for Trigger Point Injection in Myofascial Pain Syndrome of Upper- and Middle-Trapezius Muscle: A Randomized Controlled Trial

Comparison of 3 Needle Sizes for Trigger Point Injection in Myofascial Pain Syndrome of Upper- and Middle-Trapezius Muscle: A Randomized Controlled Trial

Bone marrow harvesting using EMLA (eutectic mixture of local anaesthetics) cream, local anaesthesia and patient-controlled analgesia with alfentanil

Skin analgesia with lidocaine tape prior to epidural blockade

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