Preoperative Anesthetic Cream Decreases Incisional Pain in Patients with Amyotrophic Lateral Sclerosis Undergoing Gastrostomy Placement

Abstract

Purpose: Our division of Gastroenterology has become increasingly involved in the nutritional management of patients with Amyotrophic Lateral Sclerosis (ALS). As part of their care, gastrostomy placement (PEG) has become routine. We have observed that ALS patients experience incisional pain during placement of PEG despite adequate conscious sedation and a local lidocaine injected subcutaneously. To minimize discomfort we have made it standard protocol to apply an analgesic cream prior to PEG placement. Methods: 47 patients with ALS have undergone successful PEG placement at our institution. The initial 18 patients experienced incisional pain. The following 29 patients had either EMLA Cream® (2.5% lidocaine and 2.5% prilocaine, AstraZeneca) or LMX Cream® (4% lidocaine, Ferndale) applied to the abdomen preoperatively. All patients were assessed in the recovery room prior to discharge. Results: Of the 29 patients receiving preoperative analgesic cream, only 1 expressed moderate incisional pain. The remaining 28 were relatively symptom free during and after their procedures. Conclusions: 1. Patients with ALS appear to have heightened pain sensation. 2. Our observations suggest that preoperative application of an analgesic cream greatly diminishes operative and post operative pain.