Emla cream as a local anaesthetic in MMR vaccination

Abstract

A local anaesthetic, prilocainelignocaine emulsion (Emla) has been used with increasing success in superficial dermatosurgical interventions.1-3 We investigated the analgesic effect of Emla for the subcutaneous administration of MMR vaccination in 96 children aged about 9 years in a randomised, double-blind, placebo controlled study. The children were vaccinated according to the government vaccination programme. The protocol was approved by the medical ethical committee of the University Hospital, Rotterdam. One child was withdrawn from the study. After 60 minutes' application time the patch was removed and the skin examined for eventual side-effects. Each child was then vaccinated subcutaneously with 0.5 ml MMR vaccine. The effect of Emla and placebo on the vaccination was determined by the pain experienced by each child. The level of pain was indicated by the child and by the investigator on a verbal scale as no, mild, moderate or severe pain. The child also indicated the level of pain on a 10 mm ungraded line (visual analogue scale): 0 mm represented ‘no pain’ and 10 mm ‘the worst pain you can imagine’. There was no significant difference between the verbal pain scores of the children and the investigators in the Emla group and the placebo group (Trend test). The difference in VAS scores between the Emla and the placebo groups was not significant, but almost reached significance (p= 0.052; Mann-Whitney test). None of the children showed serious side-effects. In this study Emla did not significantly reduce the pain of MMR vaccination, which is probably not in skin penetration but in the injection of the liquid into the subcutaneous space.4 Emla seemed not to provide adequate analgesia for this.