EMLA Group Research Articles

Analgesic Efficacy of EMLA Cream Among Patients Undergoing Hemorrhoidectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Post-hemorrhoidectomy pain is a concerning complication for patients and doctors, mainly due to perianal skin dissection and the complex innervation of the area. Therefore, our aim is to explore the analgesic efficacy and safety of EMLA cream among patients undergoing hemorrhoidectomy. We conducted a comprehensive search of five electronic databases (PubMed, Scopus, Web of Science, Embase, Cochrane) from inception until July 6, 2024. A risk of bias assessment was performed using the Risk of Bias Version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB-2). Only randomized controlled trials (RCTs) were included. Our outcomes of interest were pain assessment using the Visual Analogue Scale (VAS) score, patient satisfaction, meperidine dosage, frequency of meperidine requests, and single urinary catheterization. We used RevMan software to conduct the statistical analysis. Dichotomous data were pooled as relative risk (RR), while continuous data were pooled as mean difference (MD). Four RCTs were included in our review. Two RCTs showed a low overall risk of bias, while one RCT showed a high risk, and the last one showed some concerns. Our analysis showed a significant difference between the two groups, favoring the EMLA group over the control group, upon arrival at the recovery room and at night on the day of the operation (MD=-1.76, 95% CI (-3.17, -0.36), p=0.01 and MD=-1.65, 95% CI (-2.48, -0.81), p=0.0001, respectively). However, there was no significant difference between the two groups in the morning on the day after the operation (MD=-0.9, 95% CI (-2.02, 0.21), p=0.11). Moreover, patients who used EMLA cream reported increased patient satisfaction compared to those who did not. However, there was no significant difference between both groups in terms of the use of urinary catheterizations. In conclusion, our study showed that applying EMLA cream over the perianal area after hemorrhoidectomy can effectively reduce postoperative pain and decrease the required opioid dosage and patient requests. This ultimately leads to increased patient satisfaction. However, further studies are still required to confirm these findings.

Using cryotherapy, EMLA (eutectic lidocaine/prilocaine) cream, or lidocaine spray to reduce pain during arteriovenous fistula puncture: A randomized controlled trial.

In hemodialysis patients, pain associated with needle insertion into an arteriovenous fistula is a physical and psychological problem. The aim of this study was to assess the effectiveness of pre-puncture application of an ice pack, EMLA cream, or lidocaine spray to reduce pain associated with access puncture. This was a multicenter study done in nine hemodialysis centers in Iraq. The study utilized a randomized, parallel-group design, in which patients being dialyzed using an arteriovenous access were allocated into one of four groups. Access puncture was preceded by nothing (control group), by use of ice pack cooling at the puncture site, by application of EMLA cream, or by application of lidocaine spray. Pain after access puncture was assessed during a single treatment for each patient. Pain was quantified using a Visual Analogue Scale. A total of 1548 patients agreed to participate, and 1041 patients were included in the data analysis. Use of an ice pack, EMLA cream, or lidocaine spray each was associated with a lower pain score on access puncture compared with no pretreatment. The mean Visual Analogue Scores in the four groups were: 69.7 ± 15.7 in the controls, 39.8 ± 13.2 in the ice pack group, 45 ± 18.4 in the EMLA group, and 52.9 ± 15.2 in lidocaine group. Ranking of the pain severity scores suggested that ice pack use was associated with the least pain, followed by use of EMLA cream and use of lidocaine spray (severity score ranking, from lowest to highest, being 1.62, 2.18, and 2.63, respectively). Application of an ice pack prior to vascular access puncture is a fast and inexpensive technique to limit pain associated with this procedure.

Cerebral Changes Following Carpal Tunnel Syndrome Treated with Guided Plasticity: A Prospective, Randomized, Placebo-Controlled Study.

Background Compression neuropathy, such as carpal tunnel syndrome (CTS), results in changed afferent nerve signaling, which may result in changes in somatosensory brain areas. The purpose of this study was to assess cerebral changes following unilateral CTS and to assess short-term and long-term cerebral effects of guided plasticity treatment using ipsilateral cutaneous forearm deafferentation. Methods Twenty-four patients with mild-to-moderate unilateral CTS were randomized to treatment with anesthetic cream (EMLA) or placebo. Patient-rated outcomes were assessed using Boston CTS questionnaire and disability of arm, shoulder, and hand questionnaire (QuickDASH). Patients were assessed for tactile discrimination and dexterity. Cortical activation during sensory stimulation was evaluated with functional magnetic resonance imaging at 3T. Assessments were performed at baseline, 90 minutes, and 8 weeks after treatment. Results Functional magnetic resonance imaging showed that sensory stimulation of the hand with CTS resulted in significantly less cortical activation in the primary somatosensory cortex (S1) than stimulation of the healthy hand. Treatment with cutaneous forearm deafferentation on the side with CTS resulted in increased cortical activation in S1 both after the initial treatment and following 8 weeks of treatment. In addition, QuickDASH and tactile discrimination showed improvement in the EMLA group over time. Conclusions Stimulation of median nerve-innervated fingers in patients with unilateral CTS results in smaller-than-normal activation in the contralateral S1. Cutaneous forearm anesthesia on the side with CTS results in larger activation in S1, suggesting recruitment of more neurons, and a slight improvement in sensory function.

Pharmacological and non-pharmacological interventions in management of peripheral venipuncture-related pain: a randomized clinical trial

BackgroundVenipuncture is a routine nursing procedure in the pediatric ward for blood collection and transfusion. However, this procedure can cause severe pain and distress if not adequately managed.MethodsChildren aged 3–16 years old were randomized into three groups: EMLA group, distraction group, and combined group. The primary outcome was children’s self-reported pain scored using the Wong-Baker FACES® Pain Rating Scale. The parents-reported and observer-reported pain were scored using the Revised Face, Legs, Activity, Cry and Consolability Scale, and children’s salivary cortisol levels, heart rate, percutaneous oxygen saturation, venipuncture duration and retaining time of IV cannulas were the secondary outcomes.ResultsA total of 299 children (167 male, 55.8%, median age 8.5) were enrolled: EMLA group (n = 103), distraction group(n = 96) and combined group(n = 100). There was no statistical difference in self-reported pain (P = 0.051), parent-reported pain (P = 0.072), and observer-reported pain (P = 0.906) among the three groups. All three interventions can decrease children’s pain during IV cannulations. Additionally, the distraction group's salivary cortisol levels were lower than the combined group(P = 0.013). Furthermore, no significant difference was observed in the heart rate(P = 0.844), percutaneous oxygen saturation (P = 0.438), venipuncture duration (p = 0.440) and retaining time of IV cannulas (p = 0.843) among the three groups.ConclusionsAll three groups responded with slight pain during the peripheral venipuncture procedure. Therefore, medical workers in pediatric settings can use the interventions appropriate for their medical resources and availability while involving parents and children’s preferences whenever possible.Trial registrationThis trial was registered on https://register.clinicaltrials.gov/ (Gov.ID NCT04275336).

Comparison of the Effect of EMLA™ Cream and the Valsalva Maneuver on Pain Severity during Vascular Needle Insertion in Hemodialysis Patients: A Controlled, Randomized, Clinical Trial.

Background Pain due to vascular needle insertion has been reported in 40–60% of hemodialysis (HD) patients. Evidence suggests that there is typically no single method for relieving the pain of inserting vascular needles in HD patients. This study aimed to compare the effectiveness of EMLA cream and Valsalva maneuver (VM) on pain severity during vascular needle insertion in HD patients. Methods This randomized, controlled, clinical trial was conducted on 90 patients undergoing hemodialysis in the hemodialysis unit of Kowsar Hospital, affiliated with Semnan University of Medical Sciences, in Semnan, Iran. Patients were selected via convenience sampling and were randomly assigned to one of the three groups (EMLA, VM, and control groups). For the patients in the EMLA group, 2.5 g of EMLA cream was applied 60 minutes before the start of dialysis. For patients in the VM group, a maneuver was performed for 16–20 seconds before the needle was inserted. Patients in the control group received only routine care without any additional interventions. The pain severity in the three groups was measured using the visual analog scale (VAS) two minutes after vascular needle insertion. Results The results showed that the mean pain severity during cannulation was 2.06 ± 2.19 in the EMLA group, 3.2 ± 30.42 in the VM group, and 6.20 ± 1.49 in the control group, suggesting a significant difference between the groups (P < 0.001). Pairwise comparison of the mean pain severity showed that it differed significantly in the EMLA and VM groups from the control group (P < 0.001), but no significant difference was found between the EMLA and VM groups (P=0.067). Conclusion According to the results, EMLA cream was as effective as VM in reducing the pain severity caused by arteriovenous fistula (AVF) cannulation. Therefore, the use of EMLA cream and VM is recommended for reducing the severity of AVF cannulation pain. Trial Registration. Iranian Registry of Clinical Trials, Trial No : IRCT20120109008665N12, registered on 3 June 2020.

Reducing tumescent anesthetic injection pain by topical anesthesia pretreatment among patients undergoing endovenous radiofrequency ablation of varicose veins: A double-blind randomized controlled trial.

Tumescent anesthesia frequently causes the intraoperative and postoperative pain during radiofrequency ablation (RFA) of varicose veins. We have to find a way to reduce pain caused by these injections. This randomized controlled trial investigated the effectiveness of topical anesthesia pretreatment (TAP) on relieving needle puncture pain during administration of tumescent anesthesia among patients undergoing RFA of varicose veins. Eligible patients treated with RFA were recruited and randomized to either application of TAP with lidocaine-prilocaine cream (EMLA) or water-based cream (placebo). The primary outcome was patient described pain scores on the visual analogue scale (VAS) at different time points during the procedure. Secondary outcomes were technical success rate, complications, satisfaction level, expense, and extra analgesia use. Sixty-two patients were randomized: 32 to EMLA and 30 to placebo. Both groups had comparable baseline demographics, CEAP classification, and Venous Clinical Severity Score (VCSS). Less tumescent anesthetic needle puncture pain was found in the EMLA group (22 ± 7 vs 42 ± 8, p < .01). Pain scores of other time points were equivalent. There was less pain in EMLA pretreated area compared to non-pretreated area in the same patient during needle puncture (22 ± 7 vs 45 ± 7, p < .01), and similar phenomena did not appear in the placebo group. There was no statistical difference in complications, satisfaction level, expense, and technical success between the two groups. And no extra analgesia was used in all patients. We recommend the routine use of TAP to reduce the needle puncture pain during tumescent anesthesia in RFA of lower extremity varicose veins.

Comparison of Eutectic Mixture of Local Anesthesia Cream and Subcutaneous Lidocaine to Reduce Chest Tube Removal Pain and Willingness to Repeat Procedure

Background:. Patients with chest tube have allodynia (pain from stimuli that is normally painless) and hyperalgesia (increased sensitivity to pain). Anesthetics has not been used routinely when removing chest tubes assuming that the procedure is brief and that the pain is short-lived, even though it could be the most painful part of chest tube procedures.Objective: This study compared the effectiveness of local anesthetic EMLA cream and subcutaneous infiltration of lidocaine to reduce pain of chest tube removal, 10 minutes after, and it’s effect on the patient's willingness to repeat the procedure.Method: A quasi-experimental clinical trial conducted on 28 patients undergoing chest tube removal at dr. Moewardi from September 2020. The EMLA group (n = 14) received 2 grams of topical EMLA cream applied 2 hours before chest tube removal. The lidocaine group (n = 14) received subcutaneous infiltration of 2% lidocaine 5 minutes before chest tube removal. Pain was measured by VAS pain before, during, and 10 minutes after the chest tube was removed, followed by filling out a willingness to repeat procedure questionnaire.Results: Topical EMLA cream was comparable to 2% lidocaine infiltration for reducing pain during chest tube removal (p = 0.679) and 10 minutes thereafter (p = 0.833). EMLA cream did not increase the patient's willingness to repeat the procedure (p = 0.815)Conclusion: Topical EMLA cream able to replace the subcutaneous infiltration of 2% lidocaine as a local anesthetic for chest tube removal but does not increase the patient's willingness to repeat the procedure.

Use of EMLA cream for skin anesthesia and epidural insertion in the patients with cesarean delivery: A prospective double-blind randomized clinical trial.

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.

Pain Relief for Hysterosalpingography: A Randomized Controlled, Double Blinded Trial Comparing Suppository Diclofenac, Prilocaine/Lignocaine (EMLA) Cream And Placebo

Background: Hysterosalpingography is dreaded by women due to pain. Pain intensity varies with different stages of the procedure and the search for an effective analgesia continues.&#x0D; Objective: To compare the effectiveness of suppository diclofenac (100mg), cervical lidocaine 25mg -prilocaine 25mg cream (5% EMLA) and placebo in pain relief for hysterosalpingography.&#x0D; Methodology: This was a prospective, randomized, double-blinded, placebo-controlled study conducted at National Hospital Abuja, Nigeria, between November 2018 and March 2019. Participants were allocated to three groups (A, B, C). Group A received suppository diclofenac 100mg plus placebo cream, group B got EMLA cream plus placebo suppository while group C received placebo suppository and cream. Pain levels were assessed using Visual Analogue Scale (VAS) at baseline, during 4 different stages of the procedure, at 30 minutes and 24 hours after the procedure. Patients' satisfaction and side effects were also assessed. Data were analyzed using SPSS version 22 (SPSS Inc., Chicago, IL, USA). P value &lt; 0.05 at 95% confidence interval was regarded as statistically significant.&#x0D; Results: The most painful step of the procedure was during uterine distension with contrast medium with mean VAS score of 6.33±1.539, 5.37±1.377, 7.03±1.245 in group A, B and C, respectively (p-value &lt;0.05). Mean pain scores during 4 steps of the procedure were found to be significantly lower in EMLA group. Intervention groups were also more satisfied after the procedure.&#x0D; Conclusion: EMLA 5% cream is a more effective analgesic for HSG compared to both diclofenac and placebo.&#x0D; Keywords: Analgesia; EMLA; diclofenac; hysterosalpingography; visual analogue scale.

The Efficacy of Skin Cooling for Pain Relief during Intralesional Steroid Injection for Keloid Treatment: A Randomized Cross-Over Study

Objective: To evaluate if pre-treatment skin cooling can reduce the pain during steroid injection. Materials and Methods: A randomized cross-over study was conducted between September 2015 and October 2016. This study received ethical approval ID035904 No. MURA2016/152. Forty-four subjects with keloid that needed intralesional steroid injection were divided into three pretreatment groups, no treatment, skin cooling with ice pack, and skin applying with a mixture of lidocaine 2.5% and prilocaine 2.5% (EMLA®), in random order. Pain intensity was measured by using 100-mm visual analogue scale (VAS). The satisfaction levels were assessed with orderly interval rating scale from 1 to 5. Repeated-measure analysis of variance (ANOVA) and Bonferroni pairwise comparison were used for data analyses. Results: The mean VAS score at the time of needle puncturing into the skin and during steroid infiltration was statistically significant lower in skin cooling compared to no treatment group (p&lt;0.001) and EMLA group (p&lt;0.05). The satisfaction level was also statistically significant higher in skin cooling compared to no treatment group (p&lt;0.001) and EMLA group (p&lt;0.001). Thirty-seven patients (84%) selected skin cooling method as the most favorable pre-anesthetic method for intralesional steroid injection. Conclusion: Skin cooling with ice before intralesional steroid injection of keloid effectively reduces pain and patients are also satisfied. Keyword: Keloid, Corticosteroid, Pre-treatment, pain, skin cooling

Comparison of the Effect of Massage and EMLA Cream on Children's Physiological Indices During Venipuncture: A Factorial Clinical Trial

PurposeThe aim of this study was to identify the effect of massage, EMLA cream, and the combination of these two methods on changes in physiological indices because of pain caused by intravenous line insertion in preschool children. DesignA four-group randomized nonblinded clinical trial with factorial design. MethodsIn total, 140 eligible 3- to 6-year-old children entered the study in Tabriz Children's Hospital in 2017 and were randomly allocated to four groups (EMLA cream, massage, combination of the two, and control). Physiological responses were measured before and immediately after interventions in all groups. Data were collected and analyzed using SPSS version 19. FindingsComparison of the physiological indices changes caused by pain between groups showed that changes in children's heart rate (HR) and respiratory rate (RR) in the EMLA group and in the combined-method group were statistically significant (P < .05). No significant differences were found in systolic blood pressure and oxygen saturation (SPo2) between the four groups. ConclusionsResults indicated that EMLA cream was more effective than massage and a combination of EMLA and massage in reducing an increase in the HR and RR caused by pain in children. Massage alone was not effective in significantly lowering the children's increased physiological indices such as the HR and RR, and it seems the effectiveness of massage is more noticeable in conjunction with EMLA cream.

Evaluation of eutectic lidocaine/prilocaine cream for jugular blood sampling in cats

The study aimed to evaluate the efficacy of a eutectic lidocaine/prilocaine cream (EMLA cream; Astra Pharmaceuticals) in reducing pain and reaction to venepuncture during jugular blood sampling in cats after a 30-min topical application time. The study was a prospective, blind, controlled clinical trial. Eighteen healthy client-owned cats were randomly allocated to two study groups. All cats were clipped on the left jugular groove region and then, depending on the study group, either the placebo (liquid paraffin) or EMLA cream was applied to the region. The area was then kept protected for the next 30 mins. Except for the operator who administered the product, all operators were blinded to the study groups. Blood sampling was performed by an experienced operator and a stress score was assigned to each cat according to the reactions observed during the venepuncture. Also, the procedure was classified as being 'easy' or 'difficult' by the same operator. A significantly reduced stress score was observed in cats that received the EMLA cream compared with those belonging to the placebo group (P = 0.048); withdrawal movements were observed in 1/9 cats treated with the EMLA cream vs 7/9 cats of the placebo group (P = 0.015). The jugular venepuncture was defined as easy in 1/9 cats that received the placebo and in 8/9 cats in the EMLA group (P = 0.015). The present study provides evidence for the efficacy of the EMLA cream after a 30-min application time for jugular venepuncture in cats, together with significantly reduced stress for patients. Therefore, this study supports the routine use of EMLA cream as good practice to enhance the welfare of cats and to simplify venepuncture procedures.

Comparative efficacy of three topical anesthetics on 7-11-year-old children: a randomized clinical study.

BackgroundThis study evaluated the efficacy of three intraoral topical anesthetics in reducing the injection needle prick pain from local anesthetic among children aged 7–11 years old.MethodsIt is a prospective, Interventional, parallel design, single-blind, randomized clinical trial in which subjects (n=90) aged 7–11 years were included in the study based on an inclusion criteria. Subjects were divided into three groups based on computer-generated randomization with an allocation ratio of 1:1:1. Groups A, B, and C received benzocaine 20% jelly (Mucopain gel, ICPA health products Ltd, Ankleshwar, India), cetacaine anesthetic liquid (Cetylite Industries, Inc, Pennsauken, NJ), and EMLA cream (2% AstraZeneca UK Ltd, Luton, UK), respectively, according to manufacturer's instructions, for 1 minute prior to local anesthetic injection. After application of topical anesthetic agent, for all the groups, baseline pre-operative (prior to topical anesthetic administration) and post-operative scores (after local anesthetic administration) of pulse rate was recorded using Pulse oximeter (Gibson, Fingertip Pulse Oximeter, MD300C29, Beijing Choice Electronic). Peri-operative (i.e., during the administration of local anesthesia) scores were recorded using Face, Legs, Activity, Cry, Consolability (FLACC) Scale, Modified Children hospital of Eastern Ontario Pain Scale (CPS) behavior rating scale, and Faces Pain Scale (FPS-R) – Revised (For self-reported pain). Direct self-reported and physiological measures were ascertained using FPS-R – Revised and Pulse oximeter, respectively, whereas CPS and FLACC scales assessed behavioral measures. To test the mean difference between the three groups, a one way ANOVA with post hoc tests was used. For statistical significance, a two-tailed probability value of P < 0.05 was considered as significant.ResultsThe Cetacaine group had significantly lower pain scores for self-report (P < 0.001), behavioral, and physiological measures (P < 0.001) than the other two groups. However, there was no significant difference between the Benzocaine group and EMLA group during palatal injection prick.ConclusionCetacaine can be considered as an effective topical anesthetic agent compared to benzocaine 20% jelly (Mucopain gel) and EMLA cream.

Cold Vibration (Buzzy) Versus Anesthetic Patch (EMLA) for Pain Prevention During Cannulation in Children: A Randomized Trial.

The purpose of this study was to assess differences in observed pain-related behaviors during cannulation between a device combining cold and vibration (Buzzy) and the standard care (EMLA patch). Patients 18 months to 6 years old, requiring venous access in a pediatric emergency department, received either the Buzzy device or the EMLA patch. Predefined week randomization ensured equal allocation to the 2 intervention groups. Pain during cannulation was measured using the Children's Hospital of Eastern Ontario Pain Scale. Parent and nurse reports, cannulation success, and venous access times were also assessed. In total, 607 included patients were randomized into the Buzzy group (n = 302) or the EMLA group (n = 305). Observed pain-related behaviors scores, parent-assessed pain scores, and nurse-reported pain ratings were higher with Buzzy. Pain relief by a combination of cold and vibration during cannulation is not as effective as the standard-care method in children 18 months to 6 years old.

Comparison of EMLA and Diclofenac on Reduction of Pain and Phlebitis Caused by Peripheral IV Catheter: A Randomized-Controlled Trial Study.

Peripheral venous catheters (PVC) are often used to provide hydration, medications, and blood products when the length of therapy is expected to be less than 1 week. Pain and phlebitis are frequent complications of PVC. Diclofenac and EMLA have been used to minimize these adverse effects; however, conflicting results have been reported regarding which has better outcomes. This double-blind, randomized controlled trial was conducted to compare the efficacy of EMLA and Diclofenac (TDP) in attenuating PVC pain and phlebitis. The inpatient setting was chosen because of the higher frequency of PVC insertions, allowing for a sufficient sample size. One hundred fifty-four subjects were randomly assigned to three groups: EMLA patch (n = 61), a TDP patch (n = 50), or a patch with lubricant gel (n = 46) as a placebo. The pain was measured by Visual Analogue Scale (VAS). Phlebitis was examined based on Boxter criteria in intervals of 6, 12, 18, 24, and 48 hours after PVC insertion. The mean score of VAS was 41.86 ± 22.49 for the control, 39.40 ± 21.60 for TDP, and 38.77 ± 23.28 for the EMLA group, with no significant differences in pain severity between the three groups. The rate of phlebitis in the group with EMLA was significantly higher than the other two groups at 6, 12, and 18 hours (p = 0.02, p = 0.003 and p = 0.04, respectively). In all interval times, the rate of phlebitis in the TDP group was significantly lower than the other groups. Compared with men, women experienced higher rate of phlebitis and intensity of PVC pain. EMLA and TDP had similar analgesic effects, but phlebitis was less frequently observed with TDP, suggesting TDP as a potential medication for reducing pain and phlebitis before PVC insertion.

Comparative evaluation of efficacy of EMLA and needleless jet anesthesia in non-surgical periodontal therapy

The treatment of periodontitis primarily consists of mechanical debridement carried out by means of thorough scaling and root planing that might sometimes be a painful procedure which requires the administration of some form of local anesthesia. The present study comparatively evaluates the anesthetic effect of three such forms, viz; eutectic mixture of 25mg/g lignocaine plus 25mg/g prilocaine (EMLA) and needleless jet anesthesia during SRP. 30 patients with probing depth of 5mm or more and visual analog scale (VAS) score of ≥30mm on probing were selected and asked to assess the pain by VAS and verbal rating scale (VRS) during SRP after application of the two agents. The difference between the visual analogue values of control, EMLA and Madajet XL is highly significant (p <0.001). According to the VRS scores, 6.7% of the subjects in the EMLA group reported no pain, 80% mild pain, and 13.3% moderate pain. In the Madajet XL group, 46.7% reported no pain and 53.3% mild pain. In the control group 100% of the patients reported moderate pain when none of the anesthetic was administered. None reported severe pain. Thus, the data suggest that both anesthetics are able to produce anesthesia of the tissues. The needleless anesthesia was relatively superior in performance to EMLA.

The Effect of Pain Relieving Intervention During Infiltration among Gamma Knife Surgery Patients for Stereotactic Frame Fixation

This study aimed to compare the effects of three interventions on pain, blood pressure, and pulse rate during infiltration anesthesia in patients about to undergo gamma knife surgeries. The three interventions employed in a university-affiliated Hospital in J City, South Korea were as follows: EMLA cream plus Vapocoolant spray (Vapocoolant, n=30), EMLA cream plus 10.0% Lidocaine spray (Lidocaine, n=30), and EMLA cream only (EMLA, n=30). The equivalent control-group pre test - post test study design was used. Pain was assessed subjectively using the numeric rating scale (NRS) and objectively using a Galvanic Skin Response (GSR) tester. NRS scores were assessed after infiltration anesthesia and the GSR was assessed during infiltration anesthesia. Blood pressure and pulse rate were assessed twice: before and after infiltration anesthesia. Data were collected between August 3, 2016 and March 24, 2017. NRS scores after infiltration anesthesia and the GSR during infiltration anesthesia were significantly lower in the Vapocoolant group than in the Lidocaine and EMLA groups (F=13.56, p<.001 and F=14.43, p<.001, respectively). The increase in systolic blood pressure (F=4.77, p=.011) and in pulse rates (F=4.78, p=.011) before and after infiltration anesthesia were significantly smaller in the Vapocoolant group than in the Lidocaine and EMLA groups; however, no significant differences were observed in diastolic blood pressures (F=1.51, p=.227). EMLA cream plus Vapocoolant spray was the most effective intervention to relieve pain and to lower increase in systolic blood pressure and pulse rate caused by infiltration anesthesia for stereotactic frame fixation. Thus, application of Vapocoolant spray in addition to EMLA cream is highly recommended as a nursing intervention for patients undergoing gamma knife surgeries.

Comparing EMLA Cream and Ibuprofen on Pain after Insertion of Copper Intrauterine Device

Background and Objective: IUD is a safe, effective, and reversible method throughout the world, particularly in areas where population growth is too much. One of the main barriers to use IUD is the fear and pain of its insertion. Therefore, it is necessary to take measures to reduce the pain, and this study was conducted to investigate the effect of EMLA cream and ibuprofen on pain during IUD insertion. Materials and Methods: This randomized controlled clinical trial study was conducted on 120 women who admitted to Imam Javad health center in Zahedan in 2015-2016 for insertion of IUD. Women who admitted to this center were randomly assigned into 3 groups of EMLA group (n = 40), ibuprofen (n = 40), and control or placebo (n = 40). These women have no problem to insert IUD. Demographic data and pain level were recorded in a questionnaire based on Johnson’s Visual analog scale of pain at 3 stages of IUD insertion, and all IUDs were inserted by a midwife and then data were analyzed by SPSS software. Findings: The results of this research show that the lowest level of pain severity at three stages of insertion related to the EMLA cream (P < 0.01), while the maximum level of pain in the 3 groups related to Tenaculum. Conclusion: The results of the study showed that, compared to ibuprofen and placebo, EMLA cream is a safe method in reducing pain caused by IUD insertion in all stages of IUD insertion.

A Randomized Trial on the Efficacy of Topical Anesthesia for Pain Reduction during Frame Placement for Gamma Knife Radiosurgery

Background/Aims: Frame application for gamma knife radiosurgery (GKR) may be perceived as painful by patients. This study was designed to assess the efficacy of EMLA (2.5% lidocaine/2.5% prilocaine) in pain reduction. Methods: This was a prospective, randomized, and controlled trial approved by our institutional review board. Fifty-four patients undergoing outpatient GKR were divided into EMLA and placebo groups. Prior to frame placement, EMLA/placebo was applied to the patient's forehead. A visual analog scale (VAS) was used to measure pain during 4 intervals: frontal injections, occipital injections, frontal screw insertion, and overall discomfort. This study was designed to observe a difference of 1.0 on the VAS at a power of 95%. Results: VAS for EMLA versus placebo for frontal injections (5.2 ± 2.7 vs. 5.7 ± 2.0, respectively; p < 0.45), back injections, (6.5 ± 2.2 vs. 5.9 ± 2.3, respectively; p < 0.30), frontal pins (4.6 ± 2.7 vs. 4.6 ± 2.2, respectively; p < 0.99), and overall discomfort (p < 0.29) were not significantly different. A comparison between back and frontal injections for EMLA (6.54 vs. 5.19, respectively; p < 0.16) and placebo (5.89 vs. 5.68, respectively; p < 0.69) showed no significant difference between group and location (p < 0.21). Conclusion: Application of EMLA did not significantly reduce pain when used preoperatively for frame fixation. EMLA is no longer used as part of our routine for patients undergoing GKR.

Topical intranasal analgesia with EMLA for closed rhinoplasty

Background: Rhinoplasty is a traumatic procedure associated with postoperative pain. The purpose of this study is to determine the effect of topically administered intranasal EMLA 5% cream (lidocaine 25 mg/ prilocaine 25 mg) on the pain experienced in the postoperative period by patients who underwent closed rhinoplasty. Materials and methods: The study was conducted between October 2014 and May 2016 and included 66 patients divided in two groups, all of whom underwent closed rhinoplasty. In the first group (n = 33) when packaging and placing the nasal splint, each intranasal tampon (with Gelaspon) was applied with 2 ml EMLA 5% cream, and in the control group (n = 33) 2 ml Deflamol ointment was applied on each tampon. All patients were operated under general anesthesia after introduction with intravenous Propofol and maintenance of the anesthesia with Sevoflurane and opioid analgesic. After placing the patient under general anesthesia, the otorhinolaryngologist carries on with local infiltration anesthesia with a solution of lidocaine 0.5% and adrenaline 1: 100,000 4-6 ml. All patients received oral antibiotic treatment (with Klacid or Zinnat) for the period of the packaging. No corticosteroids were included in the therapeutic scheme. Post-operative pain was assessed on a visual analog scale on the 1, 3, 6, 12, 24, 48 hour in the patients of both groups. Results: The statistical analysis shows that there is a significant difference in reported results for the treatment of post-operative pain on the 1, 6 and 12 hour period in both groups studied. Four of the patients (12%) in the EMLA group had results from the VAS > 40 mm and required administration of a non-opioid analgesic in the first 24 hours, whilst in the control group this number of patients was 13 (39%). Conclusion: Intranasal application EMLA 5% cream in the packaging for reducing postoperative pain in patients who underwent closed rhinoplasty proves to be a simple and effective technique, in which we have not found adverse side effects in the study group patients despite this off label usage.