Use of EMLA cream for skin anesthesia and epidural insertion in the patients with cesarean delivery

Abstract

Background: Pain relief of epidural anesthesia in cesarean delivery is difficult. EMLA, a eutectic mixture of lidocaine and prilocaine, is effective for pain reduction during venipuncture and superficial surgery. However, its effectiveness during epidural insertion is not well elucidated. The aim of this randomized, double-blind study was to evaluate the efficacy of EMLA for epidural insertion in elective cesarean delivery. Methods: With Institutional Review Board approval and written patients’ informed consent, forty-two ASA physical status 2 patients (aged 23–45) scheduled for elective cesarean section were included in this study. The patients were randomized to applied ELMA (EMLA group) or placebo cream (Placebo group) about one hour prior to anesthesia. Pain during skin infiltration with 1% mepivacaine and subsequent insertion of Tuohy needle was assessed immediately after each procedure. The presence of patient's response with physical withdrawal on both procedures was recorded. Statistical analysis was performed using Mann–Whitney U test and Fisher's exact test. A value of P < 0.05 was considered significant. Results: Median VAS values on skin infiltration and on insertion of Tuohy needle did not differ between groups. The incidence of patient's response with physical withdrawal on skin infiltration was not different between groups. However, that on insertion of Tuohy needle was significantly lower in EMLA group than in Placebo group (0%, 21%). Conclusions: EMLA cream could not reduce the pain during epidural insertion.

Efficacy of ShotBlocker device versus vapocoolant spray for spinal needle pain relief during spinal anaesthesia in elective caesarean section - A randomised controlled trial

“…Various non-invasive techniques, such as a eutectic mixture of local anaesthetics (EMLA) creams and local anaesthetic application using needle-free drug delivery systems, have been used. [ 5 6 ] Despite comparable effectiveness with the vapocoolant spray, the delayed onset (30-60 min) of EMLA renders it unsuitable for emergency procedures. [ 2 6 7 ] The needle-free drug injection systems are not cost-effective.…”