EMLA Patch Research Articles

Comparative study of attenuation of needle prick pain of spinal anaesthesia by local infiltration analgesia versus EMLA skin patch

Abstract Introduction: Needle prick pain is a distressing event for a patient receiving spinal anaesthesia. A ‘Needle piercing the spine’ might be physically and mentally traumatizing for many patients. This may lead to unwanted panic and anxiety during the procedure of spinal anaesthesia. To avoid this distressing needle prick pain, many clinicians have resorted to the practice of giving injections of local anaesthetic or local application of EMLA cream or patch at the site of spinal puncture beforehand for anaesthetizing the skin and subcutaneous tissues. Methods: A prospective cohort study was done. Those enrolled patients were assessed by an expert anesthesiologist, who was not part of the research team, and he prescribed patients either EMLA cream or regular standard lignocaine infiltration anaesthesia and labelled them as Group E and Group L respectively. The pain score was assessed using a Visual Analogue Scale. Result: A total of 64 patients were enrolled in the study- 33 in Group E and 31 in Group L. Both groups had an almost similar number of patients who had a similar extent of surgery. Univariate analysis showed that the mean pain score (VAS) was significantly higher in Group E patients compared to that in Group L, p<0.001. The multivariate analysis had similar findings after controlling confounding factors in multiple regression analysis. Conclusion: Local 2% lignocaine injection achieved significantly more pain reduction during spinal needle insertion compared to the application of an EMLA patch before spinal anaesthesia.

Coolsense® versus EMLA® for peripheral venous cannulation in adult volunteers: A randomised crossover trial.

Peripheral venous cannulation (PVC) is a commonly performed invasive medical procedure. Topical treatments such as the eutectic mixture of local anaesthetics (EMLA®, Aspen Pharmacare Australia Pty Ltd, St Leonards, NSW) attenuate the associated pain, but are limited by requiring up to one hour of application before becoming effective. The Coolsense® (Coolsense Medical Ltd., Tel Aviv, Israel) pain numbing applicator is a new device using a cryoanalgesic means to anaesthetise skin within seconds. Coolsense is being increasingly used for cannulation, but comparative studies are lacking. We recruited 64 healthy adult volunteers to this open-label two sequence, two period randomised crossover trial. Participants had two 20 gauge venous cannulae inserted, one on the dorsum of each hand. Each cannulation attempt was preceded by treatment with Coolsense or an EMLA patch containing 2.5% lidocaine and 2.5% prilocaine. The primary outcome was participant pain using the 0-10 numerical pain rating scale. Secondary outcomes were participant satisfaction scores on a 0-10 scale, treatment preference, and failed cannulation attempts. Participants were randomly assigned to either the Coolsense EMLA (n = 32) or EMLA Coolsense (n = 32) sequence. All participants completed the trial. The pooled mean paired difference of the numerical pain rating scale was -1.84 (95% confidence intervals -1.28 to -2.41; P < 0.001) in favour of EMLA. The pooled mean paired difference for satisfaction score was 2.26 (95% confidence intervals 1.46 to 3.07; P < 0.001) higher with EMLA. Most participants preferred EMLA over Coolsense (P < 0.001). There was no significant difference regarding failed cannulation between the two treatments (P = 0.14). Among healthy individuals undergoing elective PVC, EMLA was associated with reduced pain, increased satisfaction, and was the preferred treatment compared to Coolsense.

Buzzy Device Versus EMLA for Pain Control in Pediatric IV Placement

Researchers compared pain scores during IV placement and venipuncture between children randomized to treatment with an EMLA patch (lidocaine 2.5%,

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.

Effects of a clown's presence on pain and anxiety during botulinum toxin injections in children

Botulinum toxin injections (BTI) in children often involve several sites of injections and repetitions of the procedure. Reducing pain and anxiety during this invasive procedure is a high priority but remains a challenge. The intervention of medical clowns for improving distraction during painful procedures is increasing and the question of their benefit during BTI raises. The aims of this study were to evaluate the effectiveness of medical clown presence on pain and anxiety during BTI compared to usual distraction procedures. Pain and anxiety of children between 1 and 18 years undergoing first or repetitive BIT at Brest University Hospital were evaluated. The presence of the clowns was randomized based on their availability. The usual distraction included individualized distraction, such as music, movies, discussion… Pain was evaluated using the Face Legs Activity Cry Consolability (FLACC) scale by an independent observer and using the Visual Analogic Scale (VAS) by the child and his parents. Anxiety before and during the BTI was evaluated using a VAS by the child and his parents. Proceeding of BTI was evaluated by the physician and child's parent, benefit of distraction was evaluated by child's parent, using a 4 point Likert scale. Eighty-eight children (56 males, mean age = 7.92 years, 453 injections), 42 children in the clown group and 46 in the usual distraction group were evaluated. The two groups were comparable on the main sample characteristics and in terms of procedures (Nitrous oxide, EMLA patch…). There were no significant between group differences on the FLACC and VAS anxiety. However, clown distraction was significantly better than usual distraction according to the parents. Subgroups analyses suggested that some children, like children with cognitive impairment may have a better benefit of the presence of clowns in terms of pain. The clown presence during BTI did not reduce significantly pain or anxiety in children compared to usual distraction. However, the presence of the clowns likely improves the level of distraction as evaluated by the parents, which is a key result for such a repetitive procedure. Some specific groups of children may have a better benefit of clown presence, which suggests other analyses to be performed and confirmed by future studies.

Lidocaine-prilocaine patch decreases the pain associated with the subcutaneous administration of measles-mumps-rubella vaccine but does not adversely affect the antibody response

Topical lidocaine 2.5% and prilocaine 2.5% (EMLA) is effective in decreasing the pain associated with minor procedures including immunization, although the effect on the antibody response to vaccine constituents has not been assessed. To measure the antibody response to measles-mumps-rubella (MMR) vaccine, as well as pain reduction associated with the use of the EMLA patch. One hundred sixty healthy infants at least 12 months old undergoing their first MM immunization in an ambulatory setting. Randomized, double-blind, controlled trial of EMLA patch (5%-1 g) or placebo before MMR immunization. Blood sampling before and 28 to 35 days after immunization. The primary outcome measure was the antibody response to measles by plaque reduction neutralization and to mumps and rubella by enzyme immunoassay. The secondary outcomes were pain scores by the Modified Behavioral Pain Scale and drug- and vaccine-associated adverse events. There was no difference in the antibody response between the EMLA- and placebo-treated groups. The response rates in the EMLA group were 89.7%, 88.3%, and 92.3% to measles, mumps, and rubella, respectively, compared with rates of 91.1%, 94.9%, and 93.7% in the placebo group (P >.05 for all comparisons). EMLA recipients had less pain after immunization (mean Modified Behavioral Pain Scale score increase 3.1 compared with 3.8; P =.043) and less irritability (16% compared with 31%; P =.040) than did placebo recipients. The EMLA patch has no adverse effect on the antibody response to MMR vaccine and significantly reduces the pain associated with the subcutaneous administration of the vaccine.

Comparison of the analgesic effect of EMLA cream and EMLA patch on normal skin evaluated with laser-induced pain stimuli.

In the present study the onset, duration and efficacy of the analgesic effect of EMLA patch compared to EMLA cream were investigated on the skin of the forearms of 12 healthy adults. EMLA patch and cream were applied for 30, 60 and 120 min. The pain threshold was determined 5 min after removal of the test substance, using high-energy argon laser stimuli, and thereafter every 30 min for 4 h. After 120 min of application, both EMLA cream and EMLA patch ensured total analgesia. The clinical analgesic efficacy of EMLA patch was found equal to that of EMLA cream.

The EMLA patch—a new type of local anaesthetic application for dermal analgesia in children

The skin application of EMLA cream under a Tegaderm dressing was compared in children with a new combined dressing/local anaesthetic patch--the EMLA patch. The analgesic effect during venepuncture was assessed using a visual analogue scale (patients) and a verbal rating scale (investigator). Skin adhesiveness and incidence of local skin reactions with the two types of application were also studied. The study was designed as an open randomised trial with two parallel groups. Sixty children, aged between 5 and 15 years were evaluated. After a minimum application time of 60 min an intravenous cannula was inserted. There was no difference in analgesia as assessed by the patients or the investigators. Mild discomfort at removal of the occlusive dressing/patch was observed in a few patients, but there was no difference in the adhesiveness of the Tegaderm dressing and the EMLA patch. Only mild local skin reactions (with paleness in the anaesthetised skin area) were observed in both groups. It was concluded that both the EMLA patch and the Tegaderm/EMLA cream dressing provide effective dermal analgesia for venepuncture with a 0.8 mm (outer diameter) cannula. The two types of application were indistinguishable but the ease of application of the patch is a distinct advantage.