Reduction of pain at venous cannulation in children with a eu tec tic mixture of lidocaine and prilocaine (EMLA® cream): comparison with placebo cream and no local premedication

Abstract

The local analgesic efficacy of a cream formulation of lidocaine and prilocaine (EMLA) in reducing pain at venous cannulation was investigated in children scheduled for elective surgery. Forty children participated in a double-blind, randomized comparison between EMLA and inactive placebo cream. Another group of 18 children without any local treatment was studied as an additional control material. Subjective pain scores, expressed with a visual analogue scale, were significantly lower in the EMLA group compared with both the group treated with placebo cream (P less than 0.001) and the open control group (no cream; P less than 0.01). Local pallor and slight oedema were the only side-effects, registered in both cream-treated groups. A preliminary study was also carried out with 10 children (five with EMLA and five without) in order to determine whether catecholamine and vasopressin levels in venous blood are affected by the stress and anxiety associated with venepuncture in children premedicated with oral flunitrazepam. No significant hormone responses were, however, detected. The lidocaine concentrations measured in venous blood taken from the application site of EMLA cream were low, and there were no measurable levels of lidocaine in simultaneous blood samples from the opposite extremity. In our opinion EMLA cream is safe and alleviates effectively the pain associated with venepuncture, and thus deserves a place in the routine premedication of children.

Dermal patch anaesthesia: comparison of 10% lignocaine gel with absorption promoter and EMLA cream

“…Skin pretreatments, such as stripping with gum tape or cleaning with benzene, significantly shortened the latency time of the dermal patch anaesthesia [4]. EMLA (eutectic mixture of local anaesthetics) cream was developed in the 1980s in Europe [5] and is widely used prior to venepuncture [6,7], but is not yet commercially available in Japan.In the present study, the effects of 3% GA MHPh 2Na in 10% lignocaine gel (Lido-Gel) were compared with those of EMLA cream in a randomised, double-blind fashion. …”

Topical ibuprofen for skin analgesia prior to venepuncture

“…In previous studies transient blanching has been noted with EMLA and placebo [ I , 3-61 and attributed to the effect of moisture under the occlusive dressing [I, 51 or constituents of the pharmaceutical preparation [6]. Blanching occurred only at EMLA-treated sites in this study, suggesting that it may be an effect of local anaesthetic on vascular smooth muscle [I].…”

The EMLA patch—a new type of local anaesthetic application for dermal analgesia in children

“…In clinical trials of analgesics, a visual analogue scale (VAS) has been shown to be more discriminative than a traditional, simple descriptive pain scale [8-101 and it has been reported to be reliable in children from 4-5 years of age [6,9]. Although premedication may have an influence on pain perception we found it meaningful to document the new formulation in a setting that was as close to the clinical routine as possible.…”