EMLA cream in burns: A systematic review of safety, analgesic efficacy and effects on burn pathophysiology

Abstract

AimManagement of procedural pain in burn care is challenging. Lidocaine-prilocaine cream 5% (EMLA®) is a widely used, effective local anesthetic cream approved for normal intact skin; genital mucosa for superficial surgical procedures; and debridement of chronic leg ulcers. This comprehensive review aimed to determine safety, analgesic efficacy and effects on burn pathophysiology to provide evidence-based clinical recommendations of introducing the topical anesthetic into burn care. MethodsPRISMA guidelines were followed in conducting a systematic PubMed search to include all relevant preclinical and clinical studies, according to pre-specified eligibility criteria. ResultsFifteen studies were included in a qualitative synthesis, of which nine were human and six were animal studies. To date, safety and pharmacokinetic data on EMLA application in burns are limited. Nevertheless, human studies indicated that EMLA is both safe and provides adequate procedural pain relief in adults when applied to smaller burns. Caution should be exercised when using EMLA in younger children, as systemic toxicity, pertaining to prilocaine-induced methemoglobinemia, has been reported due to overdosing (high doses applied over large burn areas). Furthermore, animal studies demonstrate potential beneficial effects of EMLA on burn pathophysiology: anti-inflammatory; decreased capillary permeability to plasma proteins and edema formation; and improved tissue perfusion – factors that may impact burn wound progression. ConclusionCurrent data for the use of EMLA in the management of procedural pain in small burns is sparse but suggests that it is safe and effective in adults. Further clinical pharmacokinetic studies are warranted, especially for application on larger burn areas.