Does a local anaesthetic cream (EMLA) alleviate pain from heel‐lancing in neonates?

Larsson, Björn; Jylli, Leena; Lagercrantz, Hugo; Olson, Gayle

doi:10.1111/j.1399-6576.1995.tb04223.x

Cited by 71 publications

(47 citation statements)

References 12 publications

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“…Preterm neonates may also respond to nonpainful stimuli in a similar way as they do to painful stimuli 37 because of a limited repertoire of responses or conditioning. The use of developmentally insensitive pain indicators such as presence or absence of infant crying 11 may have obscured differences between groups.…”

Section: Discussionmentioning

confidence: 99%

“…Larsson et al 11 used a randomized double-blind design and allocated 112 3-day-old, full-term neonates to eight different application time groups (10,20,30,40,50, 60, 90, 120 minutes) after 0.5 g of EMLA or a cosmetically identical placebo cream. Each randomization group included 7 infants treated with EMLA and 7 infants treated with placebo.…”

Section: Double-blind Randomized Controlled Studymentioning

confidence: 99%

“…[5][6][7][8][9][10][11][12][13][14][15][16][17] Two studies were excluded; 1 because an experimental procedure was used to measure pain threshold, 5 and another because it did not include a control/no treatment group. 6 Thus, 11 studies were used for the analysis.…”

Section: Efficacy Studiesmentioning

confidence: 99%

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A Systematic Review of Lidocaine-Prilocaine Cream (EMLA) in the Treatment of Acute Pain in Neonates

et al. 1998

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ABSTRACT. Objective. Neonates routinely undergo painful cutaneous procedures as part of their medical treatment. Lidocaine-prilocaine 5% cream (EMLA) is a topical anesthetic that may be useful for diminishing the pain from these procedures. EMLA is routinely used in children and adults. There is substantial apprehension about its use in neonates because of concerns that it may cause methemoglobinemia. The objective of this review was to determine the efficacy and safety of EMLA as an analgesic for procedural pain treatment in neonates and provide evidence-based recommendations for clinical practice.Methods. Systematic review techniques were used. Studies were identified using manual and computeraided searches (Medline, EMBASE, Reference Update, personal files, scientific meeting proceedings). Behavioral (eg, facial action, crying) and physiologic (eg, heart rate, oxygen saturation, blood pressure, respiratory rate) outcome data from prospective nonrandomized controlled studies and randomized controlled trials in fullterm and preterm neonates were accepted for inclusion to establish efficacy of EMLA. The risk of methemoglobinemia (defined as methemoglobin concentration >5% and requiring medical intervention) was estimated from all prospective studies.Results. Eleven studies of the efficacy of EMLA were included in the analysis. Infant gestational age at the time of delivery ranged from 26 weeks to full-term. Two studies included data from both neonates and older infants. The following procedures were studied: circumcision (n ‫؍‬ 3), heel lancing (n ‫؍‬ 4), venipuncture (n ‫؍‬ 1), venipuncture and arterial puncture (n ‫؍‬ 1), lumbar puncture (n ‫؍‬ 1), and percutaneous venous catheter placement (n ‫؍‬ 1). Nine studies were randomized controlled trials. The total sample size for each study ranged from 13 to 110 neonates. The dose of EMLA used was 0.5 g to 2 g in 9 studies, and was not specified in the others. The duration of application ranged from 10 minutes to 3 hours. The three studies that investigated the efficacy of EMLA for decreasing the pain of circumcision used a randomized controlled trial design. All of them demonstrated significantly reduced crying time during the procedure in the infants in the EMLA group compared with the infants in the control group. Facial grimacing, assessed in two of the studies, was also significantly lower in the EMLA group. Using meta-analytic techniques, the heart rate outcome data for two studies was summarized. Increases in heart rate compared with baseline values were 12 to 27 beats per minute less for the EMLA group than in the placebo group during various stages of the surgical procedure. Three studies that investigated the pain from heel lancing were randomized controlled trials; the other was a nonrandomized controlled study. None demonstrated a significant benefit of EMLA for any of the outcome measures used to assess pain (ie, behavioral pain scores, infant crying, heart rate, blood pressure, respiratory rate, oxygenation parameters). One randomized controlled study ...

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Section: Discussionmentioning

confidence: 99%

Section: Double-blind Randomized Controlled Studymentioning

confidence: 99%

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A Systematic Review of Lidocaine-Prilocaine Cream (EMLA) in the Treatment of Acute Pain in Neonates

et al. 1998

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“…Neither of these agents has demonstrated conclusive benefit in procedures such as taking blood samples from the heel and venepuncture in neonates (4)(5)(6)(7)(8). In addition, the use of EMLA has been linked to a potential increase in the risk of methemoglobinemia (9).…”

mentioning

confidence: 99%

Does topical amethocaine gel reduce pain from heel prick blood sampling in premature infants? A randomized double-blind cross-over controlled study

Patel

Czerniawski

Gray

et al. 2003

Paediatrics &Amp; Child Health

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BACKGROUND: Heel prick blood sampling is the most common painful invasive procedure performed on neonates. Currently, there are no effective ways to provide pain relief from this painful procedure. OBJECTIVE: To assess the efficacy of the topical anesthetic amethocaine 4% gel (Ametop, Smith & Nephew Inc, St Laurent) in reducing the pain of heel prick blood sampling in neonates. METHODS: A randomized, double-blind, placebo controlled, crossover trial was conducted. Neonates between 33 to 37 weeks' gestational age in their first seven days of life were eligible. Heel prick blood sampling was performed on each participant twice. Each infant was randomly assigned to receive either amethocaine 4% gel or placebo to the heel for the first prick, and then received the alternative agent for the second prick. Prick pain was assessed using both Premature Infant Pain Profile (PIPP) and Neonatal Infant Pain Scale (NIPS). Squeeze pain was assessed by NIPS. RESULTS: Ten babies were recruited. There were no significant differences in the average PIPP and NIPS scores between the treatment and placebo groups for both prick and squeeze pains from heel prick blood sampling. For prick pain, linear-regression showed significant correlation between the PIPP and NIPS scores. No adverse reactions were observed after application of either the active or placebo agents. CONCLUSION: Topical amethocaine 4% gel is not shown to reduce prick and squeeze pains significantly from heel prick blood sampling in neonates between 33 to 37 weeks' gestational age. Further studies are needed to find ways to provide effective pain relief from this common procedure.

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“…1,2 Interventions previously demonstrated to reduce the pain and distress of heelsticks include the use of automated spring-loaded devices, 3 nonnutritive sucking, 4 rocking, 5 skin-to-skin contact 6 and oral sucrose. 7 Ineffective measures include topical anesthesia (EMLA) 8 and oral analgesics (acetaminophen). 9 One reason that heelstick blood collection is painful and distressing is the prolonged squeezing of the heel required to complete the collection.…”

Section: Introductionmentioning

confidence: 99%

Can Nitroglycerine Ointment Facilitate Newborn Heelstick Blood Collection? A Randomized Controlled Trial

2003

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Newborn heelstick blood collection can be a painful procedure in part because of the time required to obtain sufficient quantity of blood. No previous studies have determined whether local vasodilatation using topical nitroglycerine ointment (NGO) would facilitate heelstick blood collection. OBJECTIVE:To determine if the topical application of NGO would reduce the time needed to collect the required amount of blood for newborn metabolic screening and, in turn, reduce the pain/distress of the procedure. STUDY DESIGN:In a randomized, prospective, placebo controlled and blinded fashion, term newborns in a well nursery received either topical nitroglycerine or placebo ointment 10 minutes prior to heelstick. Total time and number of heelsticks required to complete the collection were measured along with crying time, heart rate and blood pressure. RESULTS:In all, 50 were studied, 25 in each group. There was no statistical difference between groups in collection time, crying time or number of heelsticks required for completion. Heart rate increased significantly and equally in both groups. Blood pressures were unchanged. CONCLUSIONS:Topical NGO did not facilitate heelstick blood collection or reduce the pain/distress of the procedure.

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Does a local anaesthetic cream (EMLA) alleviate pain from heel‐lancing in neonates?

Cited by 71 publications

References 12 publications

A Systematic Review of Lidocaine-Prilocaine Cream (EMLA) in the Treatment of Acute Pain in Neonates

A Systematic Review of Lidocaine-Prilocaine Cream (EMLA) in the Treatment of Acute Pain in Neonates

Does topical amethocaine gel reduce pain from heel prick blood sampling in premature infants? A randomized double-blind cross-over controlled study

Can Nitroglycerine Ointment Facilitate Newborn Heelstick Blood Collection? A Randomized Controlled Trial

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