Eutectic Mixture Of Local Anesthetics Cream Research Articles

Acute Systemic Toxicity Caused by Topical Application of EMLA Cream on a Leg Ulcer: Case Report and Review of Literature.

Systemic toxicity of eutectic mixture of local anesthetics (EMLA) cream is rare and is most commonly observed in children, for example, upon extensive application, and rarely occurs in adults with certain dispositions. We report the case of a 71-year-old man who developed methemoglobinemia and systemic intoxication upon topical application of EMLA cream for leg ulcer and stasis dermatitis prior to surgical debridement. Approximately 45 min after application, the patient was found to be in a somnolent state, was unable to articulate, and showed peripheral cyanosis. The blood concentration of methemoglobin (MetHb) was 15.1%, and therefore, a diagnosis of systemic toxicity of EMLA due to methemoglobinemia was established. After removal of the cream, oxygen was applied, and further observation revealed that the patient's condition rapidly improved without any residue. In the following, we also discuss literature related to systemic EMLA intoxication. EMLA cream may cause severe systemic toxicity even in adults under certain conditions, for example, when applied on damaged skin or in extensive amounts.

Effectiveness of the Eutectic Mixture of Local Anaesthetics Cream in the Management of Arteriovenous Fistula Needle Insertion Pain in Patients Undergoing Haemodialysis.

This review aimed to assess the effectiveness of the eutectic mixture of local anaesthetics (EMLA) cream in the management of arteriovenous fistula (AVF) needle insertion pain in adult patients undergoing haemodialysis (HD) compared with other alternative interventions. The main search was conducted in November 2020 and updated in December 2021. In the search strategy, keywords and synonyms were used and multiple databases were searched with no date limitation to ensure a comprehensive search that would yield all studies relevant to the review and minimise location bias. A total of 209 studies were found in this search and filtered. After filtering through these studies, only five studies were finally included in the review. EMLA-cream was found to be effective in reducing AVF needle insertion pain among adult patients undergoing HD. Despite EMLA cream's effectiveness in reducing HD needle insertion pain and its fewer side effects, the findings of the included studies should be interpreted with caution, as there are some limitations, and further research is required.

Pain-Reducing Modalities Before Botulinum Type A Injections for Hemifacial Spasm Treatment: A Comparative Study

Background: Botulinum toxin A (Botox) therapy is safe and effective for hemifacial spasm, however, the associated discomfort and pain from injections limit its usefulness. Objective: To evaluate pain, preparation difficulty, and satisfaction following application of a eutectic mixture of local anesthetic (EMLA) cream, ice application, and placebo before Botox injections for hemifacial spasm. Materials and Methods: Twenty-two patients received four Botox injections in the facial area to treat hemifacial spasm, between June 2022 and March 2023. The initial treatment began in June 2022, followed by treatments at 3, 6, and 9 months. The EMLA cream, ice application, control, and placebo were administered consecutively for each Botox treatment. Pain, preparation difficulty, and satisfaction were evaluated on a 0 to 10 scale. Neurological and bleeding complications were recorded. Results: The mean pain score for EMLA cream application was the lowest, followed by cold compressions. The mean pain score in the control with placebo intervention was not significantly different from that in the control. The control without placebo intervention had the lowest difficulty in preparation score at 0.82 and showed no significant difference with EMLA application. Whereas cold compression had the highest difficulty in preparation score. The highest satisfaction score was obtained with the EMLA cream application at 9.45. The satisfaction score was higher in the control with placebo intervention at 8.32 than in the control, which had the lowest satisfaction score at 6.91. The number of injections and neurological complications did not differ among the four methods. The bleeding site ratio was the lowest with the cold compression method. Conclusion: EMLA cream application resulted in the lowest mean pain and the highest satisfaction scores. Control with placebo intervention increased the satisfaction score without reducing the mean pain score. Cold compression decreased bleeding complications, and the secondlowest mean pain scores. Keywords: Ice; Local anesthetics; EMLA; Hemifacial spasm; Botox injection; Pain reduction

Efficacy of Eutectic Mixture of Local Anesthetics (EMLA) Versus Ice as Topical Anesthetics Prior to Long Buccal Nerve Blocks: A Prospective Comparative Study.

Background Dental extraction is one of the common procedures in the field of dentistry. However, fear and anxiety about local anesthetic injections are unavoidable for most patients.Topical anesthetics, distraction techniques, acupuncture, and the application of heat or cold have been used in practice to alleviate injection-related pain. The specific aim of this study was to compare the pain-relieving efficacy of eutectic mixture of local anesthetics (EMLA) vs. ice during the administration of a long buccal nerve block (LBNB) before dental extraction. Materials and Methods In total, 20 healthy adult patients who required bilateral mandibular posterior teeth extraction under local anesthesia were enrolled.The study was conducted in the Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, from January 2023 to May 2023. It was a prospective split-mouth study in which each participant was divided into two groups according to the operative site: Group 1, which received a 5% EMLA cream, and Group 2, which received an application of ice before administration of LBNB. There was a one-week interval between the two interventions. The levels of pain and satisfaction were assessed using the visual analogue scale (VAS) and pain perception was evaluated by the sound, eye, motor (SEM) scale. Mann-Whitney U test was applied for the statistical analysis. Results The study included a total of 20 participants, with 14 being male and six being female. The mean age of the study population was 42 ± 15 years. When analyzing the pain scores using the VAS, it was found that Group 1 had a mean score of 2.4 ± 0.44, while Group 2 had a mean score of 3.0 ± 0.44. This differencebetween the two groups wasstatistically significant (P = 0.001). It was also found that the mean patient satisfaction score for Group 1 was 9.8 ± 0.22 and for Group 2 was 9.2 ± 0.40 which wasstatistically significant (p = 0.003). Similarly, Group 1 had a mean SEM score of 1.1 ± 0.1, while Group 2 had a mean SEM score of 1.30 ± 0.46 which was also statistically significant (P =0.016). Conclusion The study results revealed that EMLA has asignificant advantage over ice in terms of lower levels of pain, more patient satisfaction, and higher comfort levels.EMLA can be considered the first choice of topical anesthetics, however, ice is recommended in resource-constrained dental set-upsas it is cost-effective.

Comparison of the effects of Valsalva maneuver, EMLA cream, and the combination of both in relieving pain of needle insertion on totally implantable access port: A randomized controlled study.

Totally implantable access port (TIAP) is a subcutaneously implanted, long-term infusion device that is widely used in oncology patients. However, multiple needle insertions into TIAP may lead to pain, anxiety, and dread in patients. This study aimed to compare the effectiveness of Valsalva maneuver, eutectic mixture of local anesthetics (EMLA) cream, and the combination of both in relieving pain of cannulations on TIAP. This was a prospective randomized controlled study. We included 223 patients treated with antineoplastic drugs and randomized them into four groups: EMLA Group (Group E), control Group (Group C), Valsalva maneuver Group (Group V), and EMLA cream combing with Valsalva maneuver Group (Group EV). Each group was given the corresponding intervention before non-coring needle insertion. The data on pain scores and overall comfort were collected by numerical pain rating scale (NPRS) and visual analog scale (VAS). Group E and Group EV experienced the least amount of pain scores in needle insertion, which was significantly lower than Group V and Group C (p < 0.05). Meanwhile, Group E and Group EV obtained the highest comfort level, which was significantly higher than group C (p < 0.05). Fifteen patients developed localized skin erythema after the application of medical Vaseline or EMLA cream and subsided within half an hour after rubbing. EMLA cream is a safe and effective way to alleviate pain during non-coring needle insertion in TIAP and enhance the overall comfort of patients. We recommend applying EMLA cream 1 h before needle insertion of TIAP, especially in patients having needle phobia or high pain scores from previous non-coring needle insertion.

Literature Review for Office-Based Anesthesia

Literature Review for Office-Based Anesthesia

A comparative study of 10% lidocaine spray versus eutectic mixture of 2.5% lidocaine and 2.5% prilocaine (EMLA) to attenuate pain of peripheral venous cannulation in children: A prospective randomized control trial at a tertiary care centre.

Eutectic mixture of local anesthetics (EMLA) (2.5% lidocaine and 2.5% prilocaine) cream is the commonly used topical anesthetic for painful intradermal procedures. Topical 10% lidocaine spray has successfully been used to anesthetize mucosal surfaces. Owing to its skin penetrative properties, this study was conducted to compare dermal analgesia between 10% lidocaine spray and EMLA cream for intravenous (IV) cannulation in children. In this prospective single-blind randomized study, ninety-nine Paediatric patients were assigned into Group A (number(n) =51) with Lignocaine 10% spray applied 10 minutes and Group B (n = 48) EMLA cream applied 1 hour prior to cannulation. Vital signs were recorded before, during, and after the procedure. The primary objective of the study was assessment of severity of pain during IV cannulation using 10 cm visual analogue scale (VAS). Secondary objectives such as ease of cannulation and adverse effects were also noted. All cannulations were performed in the first attempt with no adverse effects in both lidocaine group and EMLA group. The median (interquartile range) VAS score was 2 cm (1 to 3) in both the groups with a P value of 0.58. Topical 10% lidocaine spray applied ten minutes before venous cannulation is as effective as EMLA cream applied an hour before cannulation in children in providing dermal analgesia for intravenous cannulation with an added advantage of rapid onset of action in the former group.

Comparison of the onset, depth, and duration of cutaneous anesthesia between topical 10% lidocaine and EMLA creams: a randomized, intraindividual, comparative trial

Background The eutectic mixture of local anesthetics (EMLA) is an effective cutaneous anesthetic, although its application is time consuming and poses a risk of methemoglobinemia. Currently, the efficacy of topical 10% lidocaine cream is unclear. Objective To compare the onset, anesthesia depth, and duration of topical 10% lidocaine and EMLA cream. Methods The randomized, split-body, comparative trial performed on 40 participants who received a topical 10% lidocaine cream or EMLA on forearms for 15–150 min. Pain was stimulated using a 21-gauge needle insertion and evaluated with the Verbal Pain Score. Adverse effects were recorded. Results EMLA conferred significantly better efficacy than 10% lidocaine (p < .001). For acceptable pain at 4-mm depth, the minimal application times were 40.88 and 45.38 min of EMLA and 10% lidocaine creams, respectively. With 60/120-min application, the maximal needle-insertion depths with acceptable pain were 6.61/9.47 mm (EMLA) and 6.01/8.94 mm (10% lidocaine). EMLA’s anesthetic effect showed an early increase after removal which was sustained for 60–90 min. Both creams caused adverse effects, with EMLA showing higher proportions, although the differences were statistically insignificant. Conclusion The efficacy of EMLA was superior to 10% lidocaine cream, especially regarding anesthesia onset and duration.

A comparison of anesthetic efficacy between dorsal penile nerve block (DPNB) with lidocaine and eutectic mixture of local anesthetics (EMLA) cream during neonatal circumcision.

Circumcision is often performed in neonates and is associated with significant pain. This study was conducted to compare the anesthetic efficacy of two methods of local anaesthesia for neonatal circumcision: topical eutectic mixture of local anesthetics (EMLA) cream and dorsal penile nerve block (DPNB) with lidocaine. Male neonates who presented for circumcision and met the eligibility criteria were recruited for the study and were randomly assigned to one of the two methods of anesthesia before the procedure. Anesthetic efficacy was compared by pain assessment during four standardized steps of the procedure (clamping, crushing, tying, and cutting of the foreskin, respectively) using the modified Neonatal Infant Pain Scale (NIPS), changes in transcutaneous oxygen saturation (SpO2), heart rate (HR), and preoperative and postoperative salivary cortisol levels. Patients also were evaluated after 24 hours to assess for complications. Totally, 138 babies were recruited. Significantly higher NIPS scores were observed among babies who had EMLA cream during tying (p=0.019) and cutting (p=0.043). The rise in mean HR from baseline was statistically significant throughout the procedure in the EMLA group. In the DPNB group, there was no significant rise in mean HR during crushing (p=0.919) and cutting (p=0.197). There was a significant decrease in mean SpO2 from baseline in both groups. Salivary cortisol showed significant increase in mean levels in both groups. No significant untoward effects were observed. DPNB with lidocaine has a better pain control compared with EMLA cream during neonatal circumcision. Both methods are safe in neonates.

Efficacy of Estradiol Cream for Venipuncture Pain in Obese Female Patients: A Pilot Study.

Introduction: Venipuncture is often a painful procedure causing significant anxiety, distress, and psychological consequences. We evaluated the efficacy of estradiol cream and compared it with a eutectic mixture of local anesthetics (EMLA) cream for alleviation of venipuncture pain and to make cannulation easy in female obese patients.Materials and methods: The clearance from the Institutional Ethical Committee as well as prior written and informed consent were obtained from the participants. A total of 105 obese female adult patients aged between 25 and 64 years belonging to the American Society of Anesthesiologists (ASA) physical status I and II with body mass index (BMI) > 30 kg/m2 were included in our study. The study participants were randomly allocated into three groups: In group I, a placebo cream was applied; in group II, estradiol cream was applied, and in group III, EMLA cream was applied. Any abnormal sensation at the site of application of the cream was noted and followed up at 0, 2, and 6 hours for the same. The primary outcome was the measurement of the severity of the pain experienced during venipuncture using the visual analog scale (VAS). Ease of cannulation was our secondary outcome. VAS was compared with the Z test. Statistical Package for the Social Sciences (SPSS) v16.0 software (SPSS Inc., Chicago) was used for statistical analysis. A p-value of <0.05 was considered statistically significant.Result: The final analysis was carried out on 25 patients in group I, 27 patients in group II, and 33 patients in group III. There was no significant improvement in the ease of cannulation in group II when compared to group I. The mean VAS was similar in group I and group II, whereas it was significantly reduced in group III (p < 0.05).Conclusion: EMLA cream was found to significantly reduce the pain of venipuncture in comparison to placebo and estradiol cream. There is no beneficial effect of estradiol cream in reducing the pain from venipuncture or in ease of cannulation compared to placebo.

Efficacy of eutectic mixture of local anesthetics in alleviating pain associated with lumbar puncture in newborns: a placebo compared randomized controlled trial

Background: Lumbar puncture (LP) is one of the most commonly encountered painful procedure in paediatric medicine. Research has shown that neonates too experience pain from noxious stimuli that can be more intense than what is experienced by an adult, and so have the right to receive safe, efficient and effective pain management. Objective was to determine efficacy of topical eutectic mixture of local anesthetics (EMLA) in alleviating pain associated with lumbar puncture among newborns admitted to sick newborn care unit (SNCU).Methods: The study was a one-year tertiary care teaching hospital-based randomised comparative double blinded trial among 42 neonates aged 32 weeks or more admitted to SNCU and required a diagnostic lumbar puncture, randomly assigned to one of two groups. Half hour before the procedure, 1 g of topical EMLA cream was applied to LP site in intervention group versus placebo in other group. At different stages, the heart rate, transcutaneous oxygen saturation level, and total behaviour score were captured on a video camera and rated using the neonatal facial coding system.Results: EMLA dramatically lowers pain sensitivity when compared to placebo. Total behavioural score means±standard deviation (SD) at the moment of needle insertion (EMLA: 1.05±1.24; placebo: 2.71±1.76, p≤0.001) and post procedural 5 minute later was (EMLA: 0.05±0.22; placebo: 0.81±0.92, p≤0.01). Similarly, oxygen saturation level when needle was in spinal place (EMLA: 96.76±2.45; placebo: 94.29±3.62, p=0.01) and post procedural 1 hour later was (EMLA: 98.81±1.94; placebo: 97.48±2.18, p=0.04). The heart rate of all newborns in both groups was greater than it was at baseline, although the difference was not significant.Conclusions: EMLA is an effective agent in reducing pain associated with LP among newborns.

A Comparative study on the efficacy of topical anaesthetic creams for fractional microneedling in acne scars

Acne scars are one of the commonest skin diseases encountered in clinical practice. Management of acne scars ranges from simple subcision to laser resurfacing. Topical anaesthetics can provide, non invasive mode of adequate analgesia for the management of acne scars. In a properly selected patient setting, this can even replace the need of lignocaine infiltration. Commonly available local anaesthetics creams are Eutectic mixture of local anaesthetics (EMLA) (2.5% Lignocaine and 2.5% Prilocaine) and Lignocaine Tetracaine cream (LT) (7%Lignoaine and &amp; 7% Tetracaine). To compare the anaesthetic efficacy of topical creams in the management of acne scars. This study enrolled 20 cases of acne scars planned for Microneedling, of which 10 patients received EMLA cream (group A) and 10 patients received LT cream (group B). Pain perception was recorded with Visual Analog Scale (VAS) at 30 minutes after application of the cream and during the procedure (60 minutes after cream application). Patient preference about the topical creams was asked for the next procedure. The mean pain score after 30 minutes was 3.1 for group A and 2.1 for group B. The pain score recorded during the procedure was 2.1 for group A and 0.6 for group B. Patients had minimal and transient side effects. LT cream provided adequate and long lasting analgesia when compared to EMLA cream.

Eutectic mixture of Local Anaesthetic (EMLA) an alternative for painful palatal nerve blocks: Randomised controlled trial

The purpose of this study is to compare the efficacy of EMLA to Palatal nerve blocks in providing anaesthesia to the palatal soft tissues during extraction. Seventy patients who reported for extraction of maxillary premolar and maxillary molar tooth were included in this study. These patients were divided into two groups randomly. One group consisted of patients receiving EMLA (Eutectic mixture of Lidocaine and Prilocaine) over the palatal soft tissues adjacent to the tooth with a cotton swab, and the other group consisted of patients receiving 0.4 – 0.6 ml of 2% lignocaine with 1;2,00,000 dilution adrenaline slightly anterior to the greater palatine foramen with a syringe. The mean score VAS while applying EMLA cream in group A was 0.00. In contrast, while giving palatal nerve block in group B, it was 4.09 that was statistically significant using the independent sample t-test. Likewise, the mean VAS score while extraction in the EMLA group was 0.11, whereas in palatal nerve block group was 0.00 that was not statistically significant using independent sample t-test. EMLA may be advantageous in providing palatal soft tissue anaesthesia during prophylactic extraction, thereby avoiding painful palatal nerve blocks.

Plasma fibroblast skin tightening treatment resulting in bilateral chemical eye injury secondary to EMLA cream: a case report

BackgroundPlasma fibroblast skin tightening treatment is a relatively novel and growing minimally invasive aesthetic skin procedure. The treatment claims to rejuvenate skin by improving facial lines, wrinkles and skin pigmentation associated with photo-ageing. The skin is often anaesthetised prior to the procedure with topical creams such as EMLA (Eutectic mixture of local anaesthetics). We present the first case of bilateral chemical eye injury following plasma fibroblast skin tightening treatment secondary to EMLA cream. EMLA cream was inadvertently administered to both eyes in preparation for the treatment.Case presentationA patient was referred from the emergency department to a tertiary ophthalmology centre with bilateral exquisite eye pain, inability to open the eyes, photosensitivity and reduced vision. She underwent cosmetic plasma fibroblast skin tightening treatment at her local salon four hours earlier. She was found to have bilateral alkali chemical eye injuries with significant diffuse corneal epithelial loss. The injury was thought to be caused by inadvertent ocular exposure to EMLA cream, which was used in preparation for the plasma fibroblast skin tightening treatment. She was treated with topical antibiotics and achieved satisfactory recovery.ConclusionThis case report highlights a possible complication following plasma fibroblast skin tightening treatment. We lay emphasis on the importance identifying chemical injury and recommend that medication attention should be sought if there is any concern.

Comparison of the Effects of Vapocoolant Spray and Topical Anesthetic Cream on Pain During Intraarticular Injection of the Shoulder: A Randomized Double-Blind Controlled Trial

ObjectiveThis study was performed to compare the effects of a vapocoolant spray and a eutectic mixture of local anesthetics (EMLA) cream on reducing pain during intra-articular (IA) injection of the shoulder. DesignDouble-blind randomized placebo-controlled clinical trial. SettingUniversity hospital. ParticipantsPatients (N=63) who underwent IA injection of the shoulder joint were randomized into the spray group, EMLA group, or placebo group. InterventionPlacebo cream+vapocoolant spray (spray group), EMLA cream+placebo spray (EMLA group), or placebo cream+placebo spray (placebo group) before IA injection. Main Outcome MeasuresA 100-mm visual analog scale (VAS) for injection pain and 5-point Likert scales for participant satisfaction and preference for repeated use were administered immediately after IA injection. ResultsThe VAS scores for pain during IA injection were 30.0 (95% CI, 19.7-41.2) in the spray group, 50.0 (95% CI, 37.7-63.0) in the EMLA group, and 53.8 (95% CI, 41.6-65.0) in the placebo group (F=6.403, P<.01). The spray group showed significantly better Likert scale scores than the placebo group for participant satisfaction (P=.003) and preference for repeated use (P<.001). ConclusionsVapocoolant spray was effective in reducing pain during IA injection of the shoulder.

Acute cortisol and behavior of dairy goat kids administered local anesthesia, topical anesthesia or systemic analgesia prior to cautery disbudding

Cautery disbudding of goat kids causes thermal burns and tissue destruction, which results in acute and post-operative pain and negatively affects animal welfare. The objectives of this study were to evaluate acute cortisol concentrations and behavioral responses associated with (1) injecting a lidocaine ring block prior to cautery disbudding and comparing this to saline injections and (2) pain mitigation strategies (lidocaine ring block, topical eutectic mixture of local anesthetics (EMLA) cream, oral meloxicam) on cautery disbudded dairy goat kids. Sixty doe kids were allocated to one of six treatments: (1) disbudding without pain relief (DB), (2) a ring block using 1% lidocaine (DBLA) 20 min before disbudding, (3) saline injection (DBSA) 20 min before disbudding, (4) oral meloxicam 60 min before disbudding (DBMEL), (5) EMLA cream rubbed into the buds 60 min before disbudding (DBEM) and (6) handled but not disbudded (HAND). Blood was sampled pre- (-20 and -5 min) and post-treatment (15 and 30 min) to assess plasma cortisol concentrations and behavior during treatment was recorded using video cameras to assess rump movements, tail shakes and vocalizations (values presented as number/treatment). DBLA and DBSA kids showed elevated cortisol above baseline 5 min pre-disbudding (after injections) (P ≤ 0.01), which was no different to cortisol 15 min post-disbudding (P > 0.05). Rump movements and tail shakes of DBLA (5.5 ± 0.8 and 6.9 ± 1.2) and DBSA kids (5.6 ± 0.8 and 7.2 ± 1.2) were no different to those of DB kids (P > 0.10). Cortisol was elevated from baseline for 30 min post-disbudding for DBEM kids and DBMEL kids (P ≤ 0.05). Rump movements, tail shakes and vocalizations of DBEM (5.7 ± 0.8, 6.3 ± 1.2 and 11.1 ± 1.6) and DBMEL kids (5.3 ± 0.8, 8.0 ± 1.2 and 9.1 ± 1.6) were no different to those of DB kids (P > 0.05). HAND kids showed no change in cortisol over time (P > 0.10) and performed fewer rump movements, tail shakes and vocalizations than all treatments (P ≤ 0.01). In conclusion, lidocaine injection using a ring block appears to cause more pain than handling alone and may not reduce pain associated with cautery disbudding; therefore, a lidocaine ring block may not be a useful pain mitigation strategy for disbudding dairy goat kids. There was no evidence that meloxicam reduced acute pain and EMLA cream may have intensified the pain associated with disbudding. Further research on efficacious pain mitigation strategies for cautery disbudding of dairy goat kids is required.

Efficacy of Eutectic Mixture of Local Anesthetics on Pain Control During Extracorporeal Shock Wave Lithotripsy: A Systematic Review and Meta-Analysis.

BackgroundThe efficacy of a eutectic mixture of local anesthetics (EMLA) for pain control in extracorporeal shock wave lithotripsy is unclear. The aim of this study was to assess the effect of EMLA cream on pain control during extracorporeal shock wave lithotripsy.Material/MethodsWe searched Medline, EMBASE, and the Cochrane Central Register of Controlled Trials to identify relevant randomized controlled trials that compared the pain control efficacies of EMLA vs. placebo.Study eligibility criteria, participants, and interventions: Randomized controlled trials that compared the effect of EMLA with placebo cream for patients underwent extracorporeal shock wave lithotripsy.Study appraisal and synthesis methods: Two review authors extracted data independently using a designed data extraction form and risk of bias by Cochrane Collaboration’s tool.ResultsNine studies, including 10 randomized controlled trials with 1167 patients, were eligible. The EMLA group experienced less pain (mean difference, −0.47; 95% confidence interval, −0.78 to −0.16; p=0.003) and shorter duration of lithotripsy (mean difference, −1.70, 95% confidence interval: −2.31 to −1.10, p<0.0001) than the placebo group. There were no significant differences in the number of patients who needed extra intravenous medication (p=0.610), number of patients with insufficient extracorporeal shock wave lithotripsy pain control (p=0.530), and number of patients with opioid adverse effects (p=0.320). Limitations: Long interval between the studies, different kinds of lithotripters.ConclusionsEMLA can reduce pain during the ESWL procedure.

Comparison between Vapocoolant Spray and Eutectic Mixture of Local Anesthetics Cream in Reducing Pain during Spinal Injections.

Background Eutectic mixture of local anesthetics (EMLA) cream is often used for local anesthesia during spinal injections. However, this agent has delayed onset of action while vapocoolant spray serves more advantages. The vapocoolant spray containing ethyl chloride has fast onset and is safe, low cost, and widely available. This study aimed at comparing the effectiveness of vapocoolant spray and EMLA cream in reducing pain for spinal injections. Methods This was an experimental study on 94 subjects with 47 subjects treated with EMLA cream and 47 subjects treated with vapocoolant spray. The effectiveness of anesthesia was assessed by using Numeric Pain Rating Scale (NPRS) and patient movement during the surgery. Results This study found that the pain scale was NPRS 0 (0–3) for the EMLA group and NPRS 0 (0–4) for the vapocoolant spray group. There was no significant difference between two groups for pain scale according to the Mann–Whitney U test. For patient movement, the movement was reported only in one (2.1%) patient in the EMLA group and one (2.1%) patient in the vapocoolant spray group. Based on Fisher's test, there was no significant difference between the two groups for patient movement. Conclusions Both EMLA cream and vapocoolant spray were equally effective in reducing pain during spinal injection. There was no difference in degree of pain reduction and patient movement between the EMLA cream group and the vapocoolant spray group during spinal injection.

A comparative trial of ice application versus EMLA cream in alleviation of pain during botulinum toxin injections for palmar hyperhidrosis.

BackgroundBotulinum toxin is a safe and effective therapy for palmar hyperhidrosis, but the associated pain from injections limits the usefulness of this method of treatment.PurposeTo evaluate the efficacy of Eutectic Mixture of Local Anesthetics (EMLA) cream versus ice application in alleviation of pain during botulinum toxin injections for palmar hyperhidrosis.MethodsIn this prospective study, 23 patients underwent palm Botox injections to treat their excessive sweating. In each patient, EMLA cream was applied to one palm and ice was applied directly before the injections in the other palm. Pain was evaluated using a Visual Analog Scale.ResultsStatistically, there was a significant difference in pain control between EMLA cream group and ice application group (p<0.05). The average pain score on the hands where EMLA cream was applied was 8.9 (SD=0.81), whereas it was 4.8 (±0.9) in the ice group.ConclusionIn this study, the successful use of ice application in reducing pain by 40% in comparison to EMLA cream during Botox toxin injection for palmar hyperhidrosis is demonstrated.

Does the Application of Heat Gel Pack After Eutectic Mixture of Local Anesthetic Cream Improve Venipuncture or Intravenous Cannulation Success Rate in Children? A Randomized Control Trial

Needle-related procedures are the most common sources of pain for children in the hospital setting. The most used topical anesthetic, eutectic mixture of local anesthetic (EMLA) cream, may cause transient vasoconstriction. It has been postulated that this vasoconstriction may decrease vein visualization. The application of heat gel pack after removal of EMLA cream in the site of venipuncture counteracts the vasoconstriction, improving vein visualization. We assessed using a prospective randomized controlled trial whether the application of heat gel pack increases the needle procedure success rate. The primary study outcome was procedural success rate at the first attempt. The study enrolled 400 children, 200 of whom applied heat gel pack after removing EMLA (treatment group) and 200 did not (control group). Procedural success rate at the first attempt, vein perception before procedure, procedural pain, and adverse events were recorded in both groups. Eighty-eight percent of the procedures were successful at the first attempt in the treatment group and 89% in the control group (P = 0.876). Vein perception was not significantly different in the 2 groups (P = 0.081). Pain score after the procedure was similar in the 2 groups. This study shows that the application of heat gel pack after removal of EMLA cream does not improve venipuncture or intravenous cannulation success rate.