Efficacy of EMLA™ cream for reducing pain associated with venepuncture in felines

Abstract

PICO question
 In adult cats undergoing a venepuncture procedure, does the application of a topical lidocaine based anaesthetic to the skin at the venepuncture site reduce the severity of signs associated with pain when compared to no topical anaesthetic?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Four papers were critically reviewed. Three were prospective, double-blind, randomised, controlled clinical trials, and one was a prospective, double-blind, controlled experimental trial
 Strength of evidence
 Moderate
 Outcomes reported
 The application of Eutectic Mixture of Local Anaesthetics (EMLA™) cream to clipped skin over the procedure site, a minimum of 30 minutes prior to the venepuncture procedure, significantly reduced the severity of pain-associated behaviours during jugular phlebotomy in healthy, conscious feline patients when compared to a placebo1,2. In felines sedated with dexmedetomidine and either methadone or nalbuphine, the administration of EMLA™ cream to clipped skin for 20 minutes significantly decreased the severity of pain responses during intravenous (IV) cephalic vein catheterisation when compared to no treatment3. In clinically unwell feline patients, the use of EMLA™ cream on clipped skin at the site of jugular catheterisation 60 minutes prior demonstrated reduced pain responses compared to a placebo, but further investigation with a larger sample size is required to verify statistical significance4
 Conclusion
 The available evidence moderately supports the hypothesis that EMLA™ cream is an effective and noninvasive treatment for providing enhanced pain-relief during jugular and cephalic vein phlebotomy for the purposes of blood collection and catheterisation, respectively. The areas for treatment should be clipped free of hair, and the cream applied for a minimum of 30 minutes in non-sedated cats and 20 minutes in cats sedated with dexmedetomidine and either methadone or nalbuphine. Moreover, when applied to normal, intact skin and covered by an occlusive bandage to avoid ingestion, it is well supported by supplementary evidence that EMLA™ cream has a wide safety margin for topical use in cats4,5
 
 How to apply this evidence in practice
 The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
 Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.