Eutectic Mixture Of Local Anesthetics Group Research Articles

Comparing the Efficacy of 5% EMLA Cream and 20% Benzocaine Gel on Gingival Tissue Surrounding Non-Carious Cervical Lesions for Reduction of Pain Following Rubber Dam Clamp Placement: A Split-Mouth Randomized Clinical Trial.

Aim The aim of this study was to evaluate the effectiveness of 5% eutectic mixture of local anesthetics (EMLA) cream and 20% benzocaine gel in reduction of pain during rubber dam clamp placement in the treatment of non-carious cervical lesions (NCCLs). Methodology In this split-mouth single-blind randomized clinical trial, 50 adult participants were selected from the outpatient department. The test group was treated using 5% EMLA cream for three minutes, and visual analog scale (VAS) scores were recorded. The comparison group was treated using 20% benzocaine gel and procedure was repeated as that in the test group. After recording the VAS scores, NCCLs in both the groups were restored using composite restoration. Results In the included 50 participants, 70% were males, with an age group of 31-67 years. The mean VAS score at 3 minutes in EMLA group was significantly lower than that in benzocaine group. Conclusion Application of 5% EMLA cream for 3 minutes showed greater pain reduction during rubber dam clamp placement as compared to 20% benzocaine gel in adult patients with NCCLs.

Comparison of 2% lidocaine infiltration and eutectic mixture of local anesthetics cream application before spinal needle insertion for pain reduction and assessment of maternal satisfaction levels in women undergoing cesarean section at a tertiary care se.

This study aimed to compare two analgesic pretreatment techniques for assessing pain reduction before spinal needle insertion and the subsequent patient satisfaction levels in pregnant female patients undergoing cesarean sections. Sixty pregnant female patients scheduled for elective cesarean section under spinal anesthesia were randomly assigned to two groups. The Lidocaine group received local skin infiltration with 2% lidocaine pretreatment before spinal needle introducer insertion, whereas the eutectic mixture of local anesthetics (EMLA) group received EMLA (lidocaine 2.5% and prilocaine 2.5%) cream pretreatment for at least 30 min before spinal needle introducer insertion. Subjective and objective pain scores, procedure duration, number of attempts, maternal satisfaction, and decisions regarding future numbing procedures and regional anesthesia were assessed. The demographic characteristics of the patients were similar between groups. The mean visual analogue scale pain score was significantly lower in the EMLA group compared to the lidocaine group (P < 0.05). Additionally, the objective pain score was significantly lower in the EMLA group (P < 0.05). The duration of spinal block placement was significantly longer in the lidocaine group than in the EMLA group (P < 0.05). The number of attempts to perform the spinal block placement was similar in both groups. However, women in the EMLA group expressed greater overall satisfaction than those in the lidocaine group (76.7% vs. 20.0%, P < 0.05). Analgesic pretreatment with EMLA cream is superior to local skin infiltration with lidocaine in pregnant patients undergoing elective cesarean section under spinal anesthesia.

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.

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.

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.

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.

THE EFFECTIVITY OF EUTECTIC MIXTURE OF LOCAL ANESTHETICS CREAM AS EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY ADJUVANT ANALGESIA IN SOETOMO GENERAL HOSPITAL

Objective: The Extracorporeal Shockwave Lithotripsy (ESWL) procedure is the first choice for kidney stone therapy with the size ≤20mm. One of the complications of ESWL is the pain. Pain control during ESWL is essential to maintain the focus point of ESWL and give enough time to achieve complete stone fragmentation. Until now there is still no data about the effectiveness of Eutectic Mixture of Local Anesthetics (EMLA) cream as an adjuvant analgesic for ESWL procedure in Soetomo Hospital Surabaya. To compare the onset of pain and ESWL Wong-Baker Pain Scale (WBPS) between the EMLA group and placebo group. Material &amp; Methods: The design of this study was a single-blind randomized control trial comparing the onset of pain and Wong Baker pain scale between the patient in EMLA group and placebo one. WBPS is assessed in minute 15, 30, 45, and 60 of ESWL sessions and 60 minutes post ESWL procedure. The results were analyzed with SPSS. Pain onset and differences of WBPS were tested by using independent T-test if the data is normally distributed and using Mann-Whitney test if the data is not normally distributed. Results: 10 patients were obtained in each group. The mean onset of pain in the EMLA group was longer than the mean onset of pain in the placebo group but statistically not significant (p&gt;0.05). The WBPS in the EMLA group was significantly lower compared with the placebo group in the 30, 45, and 60 minutes of ESWL (p&lt;0.05). Conclusion: EMLA cream application before ESWL was effective and safe as an adjuvant analgesic to reduce pain during ESWL.

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.

Lidocaine-Prilocaine Cream as Analgesia for IUD Insertion: A Prospective, Randomized, Controlled, Triple Blinded Study.

Introduction:Copper IUD is a long term and reversible contraception which equals tubal ligation in terms of sterilization. One of the barriers to using this contraception method is the fear and the pain associated with its insertion. Eutectic mixture of local anesthetics (EMLA) 5% is a local anesthetic that contains 25 mg lidocaine and 25 mg of prilocaine per gram. Application of topical analgesic cream to the cervix for laser surgery, hysteroscopy and hysterosalpingography is knownAims:this study aimed to determine the effect of EMLA on IUD insertion pain.Methods:This triple blind clinical trial was conducted on 92 women in a clinic in Hamedan in 2012. After applying the cream on the cervix, pain in three steps, after using Tenaculum, after inserting hystrometr and after inserting IUD and removing IUD insertion tube were assessed with visual analog scale and were compared in EMLA group and placebo groupStatistical analysis used to determine and compare the pain of independent t tests, Mann-Whitney U test and repeated measures analysis of variance and chi-square tests to determine the homogeneity of variables and Fisher’s exact test was usedResults:Insertion hystrometr was determined as the most painful IUD insertion. The mean pain at step 2 (inserting hystrometr) was (3/11±2/53) in EMLA group, (5/23±2/31) in placebo group. EMLA cream significantly reduced the pain after using tenaculum (P<0/001), pain inserting Hystrometr (P< 0/001) and pain at IUD insertion and removing insertion tube (P< 0/001)Conclusions:Topical Application of EMLA 5% cream as a topical anesthetic on the cervix before insertion IUD reduced the pain during this procedure.

DPT 예방접종 시 냉각 스프레이와 EMLA의 통증경감 효과

우리나라 질병관리본부는 전염병 예방을 목적으로 국가 필수 예방접종을 정하여 특정 시기에 접종하도록 권장하는데, 대부분의 예방접종이 만 2세 전에 집중되어 있어 필수 예방접종만 투여 받더라도 영아는 14~20회 정도 접종을 받게 된다. DPT (diphtheria, pertussis, and tetanus) 는 제2군 법정전염병인 디프테리아, 백일해, 파상풍 예방을 목적으로 생후 2, 4, 6, 18개월 영아에게 근육주사하게 된다. 근육주사 시 주사 바늘 천자 및 약물 주입에 따른 통증이 유발되는데, 본 연구는DPT 예방접종을 받는 2, 4, 6개월 영아 49명을 대상으로 예방접종 시 유발되는 통증경감을 위해 국소마취용 크림인 EMLA (eutectic mixture of local anaesthetics)와 냉각 스프레이의 통증경감 효과를 조사하였다. 연구 결과 EMLA 적용군이 대조군과 냉각 스프레이 적용군에 비하여 주사 전후 맥박수와 산소포화도에 변화가 거의 없어 생리적 반응에서 통증경감 효과가 있는 것으로 나타났다. 결론적으로 EMLA 적용 군이 통증반응에 대한 생리적 변수, 즉 맥박수와 산소포화도를 정상범주로 유지하는데 있어서 냉각스프레이보다 더 효과적인 중재로 검증되었으므로 향후 DPT 예방접종 시 EMLA 크림의 적용 가능성을 시사하는 바이다. This study aimed at identifying the effect of vapocoolant spray and EMLA (eutectic mixture of local anesthetics) cream upon DPT (diphtheria-pertussis-tetanus)vaccineassociated injection pain in infants. A nonequivalent control group pretest-posttest design was used. The subjects were 49 infants, 19 of them for control group, 15 of them for vapocoolant group, and 15 infants for EMLA group. Pulse and oxygen saturation as pain indicators were measured before and after DPT vaccination. FLACC was also measured after vaccination. The data were collected between October 2009 and June 2010 and analyzed using SPSS WIN 20.0. EMLA group had significant a little changes in pulse (F=43.37, p <.001) and oxygen saturation (F=9.86, p=.003) compared to the control and vapocoolant group. But there was no difference in FLACC pain score among three groups. This results showed that EMLA cream is an effective agent for reducing DPT vaccination-associated pain. Therefore, EMLA cream can be used to reduce pain at public health centers and clinical settings.

A Comparative Evaluation of Local Application of the Combination of Eutectic Mixture of Local Anesthetics and Capsaicin for Attenuation of Venipuncture Pain

Topical capsaicin and eutectic mixture of local anesthetics (EMLA) have been found to be equally effective in minimizing the pain of venipuncture. After the injection of capsaicin, both tertiary amine local anesthetics and their quaternary ammonium derivatives can elicit a prolonged and predominantly sensory/nociceptor selective block. We hypothesized that the combined application of capsaicin and ELMA will be more effective than their individual effect, and lower concentrations of individual drugs in this mixture may also be associated with reduced side effects. One hundred twenty patients were randomized into 4 equal groups. The control group received plain lubricant cream; the EMLA group received EMLA cream; the capsaicin group received Myolaxin ointment (containing oleoresin capsaicin equivalent to capsaicin 0.075% w/w, methylsalicylate IP 20% w/w, menthol IP 10% w/w, camphor USP 5% w/w, and eucalyptus oil IP 5% w/w); and the EMLA + capsaicin group received EMLA cream and Myolaxin ointment mixed in equal amounts. An anesthesiologist applied the cream to a 10-cm(2) area (site of venous cannulation) on the dorsum of the nondominant hand of the patient 1 hour before venipuncture and covered the area with an occlusive transparent dressing. Venipuncture was performed with an 18-gauge cannula after removing the dressing. Venipuncture pain was graded by the patient on a 0 to 10 visual analog scale, where 0 means no pain and 10 means worst imaginable pain. P values (after correction for multiple comparisons) of <0.05 were considered significant. The incidence of no pain on venous cannulation (primary end point) was 0% in the control group (0/30). The incidence of no pain were significantly higher in the EMLA group (32%, 9/28, 95% corrected confidence interval for the difference 12%-57%, P = 0.0025), capsaicin group (30%, 9/30, 10%-53%, P = 0.0031), and EMLA + capsaicin groups (47%, 14/30, 25%-69%, P < 0.0001). Severity of venipuncture pain as assessed by visual analog scale median (interquartile range) was lower in the EMLA + capsaicin group 1 (2) compared with other groups 3 (1), 1.5 (3), and 1.5 (3) for control, EMLA, and capsaicin, respectively (P < 0.001, P = 0.04, and P = 0.04, respectively). We observed that the combination of capsaicin and EMLA in a low concentration is as effective in managing venous cannulation as when applied as an individual drug alone. Larger studies with varying concentration of capsaicin and EMLA are recommended to more fully evaluate the potential advantages.

Comparison of the Effects of Vapocoolant Spray and Topical Anesthetic Cream on Pain During Needle Electromyography in the Medial Gastrocnemius

ObjectiveTo compare the effects of a vapocoolant spray and an eutectic mixture of local anesthetics (EMLA) cream in reducing pain during needle electromyography examination. DesignRandomized controlled trial. SettingPhysical medicine and rehabilitation department of a university hospital. ParticipantsAdults who underwent needle electromyography (N=99) were randomized to 1 of 2 experimental groups or the control group. Two patients dropped out during the study. InterventionsIn the experimental groups, vapocoolant spray or EMLA cream were applied before needle electromyography. In the control group, needle electromyography was performed without pretreatment. Main Outcome MeasuresIntensity of pain associated with needle electromyography was assessed using a 100-mm visual analog scale (VAS). Patient satisfaction and preference for repeated use were measured using a 5-point Likert scale. ResultsVAS score for pain intensity was significantly lower in the spray group (31.9; 95% confidence interval [CI], 22.0–41.7) compared with the control group (52.9; 95% CI, 45.9–60.0; P=.002), whereas there was no significant difference between the EMLA cream group (42.4; 95% CI, 34.2–50.7) and the control group. Patient satisfaction and preference for repeated use were higher in the spray group than the EMLA group. ConclusionsVapocoolant spray was more effective than EMLA cream in reducing pain during needle electromyography.

Does EMLA cream application interfere with the success of venipuncture or venous cannulation? A prospective multicenter observational study

Venipuncture and intravenous cannulation are the most common painful procedures performed on children. The most widely used topical anesthetic is eutectic mixture of local anesthetics (EMLA). EMLA use is associated with a transient cutaneous vasoconstriction which can make it difficult to identify veins. We assessed with a prospective, multicenter, observational study whether EMLA interferes with venipuncture and intravenous cannulation. The primary study outcome was a success at first attempt in the course of venipuncture or venous cannulation. The study enrolled 388 children; 255 of them received EMLA and 133 did not. Eighty-six percent of procedures were successful at the first attempt in the EMLA group and 76.7% in the no EMLA group. In this study, EMLA use did not interfere with the success of venipuncture or venous cannulation in children.

Comparison of topical anesthetic cream (EMLA) and diclofenac suppository for pain relief after hemorrhoidectomy: a randomized clinical trial

We compared the efficacy and side effects of diclofenac and a topical eutectic mixture of local anesthetics (EMLA) for pain relief after hemorrhoidectomy. Ninety patients, nominated for elective hemorrhoidectomy, were recruited for this randomized clinical trial and were randomly categorized into three groups (30 patients in each group). After surgery, the patients in the first group received one 100 mg diclofenac suppository, those in the second group received 5 g of EMLA, and those in the third group received 5 g of petrolatum ointment (control group). The pain intensity was measured using a visual analog scale (VAS). Twenty-five mg of intramuscular pethidine was administered upon the patient's request. Pain measurements were performed on the patient's transfer to the recovery ward, 2 h after surgery, the evening and the morning after surgery. The EMLA group yielded the lowest VAS score on transfer to recovery and at 2 h after surgery (p < 0.05). The diclofenac group reported the lowest VAS score in the evening and the morning after surgery (p < 0.05). Topical use of an EMLA cream is appropriate for short-term pain control following hemorrhoidectomy, while diclofenac yields a more sustainable pain control.

Dimethyl sulfoxide with lignocaine versus eutectic mixture of local anesthetics: prospective randomized study to compare the efficacy of cutaneous anesthesia in shock wave lithotripsy

The objective of the study was to compare the efficacy of dimethyl sulfoxide (DMSO) mixed with lignocaine and eutectic mixture of local anesthetics (EMLA) cream as topically applied surface anesthetics in relieving pain during shock wave lithotripsy (SWL) in a prospective randomized study. Of the 160 patients, 80 patients received DMSO with lignocaine and 80 patients received EMLA cream, applied to the skin of the flank at the area of entry of shock waves. SWL was done with Seimens lithostar multiline lithotripter. The pain during the procedure was assessed using visual analog and verbal rating scores. The mean visual analog scale scores for the two groups were 3.03 for DMSO group and 4.43 for EMLA group. The difference of pain score on visual analog scale was statistically significant (p<0.05). Similarly, the pain scores as rated on the verbal rating scale were also evaluated; the mean score on verbal rating scale were 2.34 for DMSO group and 3.00 for the EMLA group. The difference between the pain score on verbal rating scale was also found to be statistically significant (p<0.05). Our study showed that DMSO with lignocaine is a better local anesthetic agent for SWL than EMLA cream. The stone fragmentation and clearance rates are also better in the DMSO group.

Comparison of Three Analgesic Treatment Protocols for Pain Management during Extracorporeal Shock Wave Lithotripsy

Introduction: In this prospective and randomized study, we aimed to compare the efficacy of a eutectic mixture of local anesthetics (EMLA) cream, diclofenac sodium (DS) and EMLA in combination with DS (EMLA+DS) for pain management during extracorporeal shock wave lithotripsy (ESWL). Patients and Methods: 120 patients who had undergone ESWL for renal stones were included in the study. The patients were randomized into three groups: the first group was treated with a eutectic mixture of local anesthetics cream (EMLA), while intramuscular DS was applied to the second group and EMLA+DS was applied to the third group. Pain during ESWL was assessed with the 10-score linear and visual analogue pain scale and was compared between groups. Results: Mean age was 44.4 ± 1.9 years. There was no statistically significant difference between groups regarding patients’ mean age, weight, stone size, shock waves, duration of ESWL and energy level values (p > 0.05). The mean pain score during ESWL was 3.90 ± 0.16 in the EMLA group, 3.28 ± 0.18 in the DS group and 3.05 ± 0.18 in EMLA+DS group (p = 0023). Conclusion: DS appears to be more efficient than EMLA in reducing pain during ESWL. Using EMLA+DS has no superiority in relieving pain compared to DS-only treatment.

Eutectic Mixture of Local Anaesthetics vs Nitrous Oxide for Cannulation of Children in the Emergency Department

ABSTRACTAimTo compare the effectiveness of eutectic mixture of local anaesthetics (EMLA) and nitrous oxide (N2O) in reducing the pain of IV cannulation/venipuncture in children in the ED.MethodA randomised, non‐blinded clinical trial undertaken in a large metropolitan ED. Eligible patients were aged 3 to 15 years and needed IV cannulation/venipuncture. The Wong‐Baker FACES pain rating scale was used to measure the child's pain. A 5‐point ordinal scale (very unsatisfied to very satisfied) was used to measure parental satisfaction with the method used.Results56 patients received N2O and 45 received EMLA. The groups had similar gender and age profiles. The median pain score was 1 (interquartile range 0–2) for the N2O group and 1 (interquartile range 1–2) for the EMLA group (p = 0.85). The median parental satisfaction scores were 5 (interquartile range 4–5) for both methods (p = 0.29). 8 (14.3%; 95% CI 6.8–26.8) patients in the N2O group experienced minor adverse events—drowsiness (3), carpopedal spasm/paraesthesia (2), agitation (1), vomiting (1), dizziness (1). One (2.2%; 95%CI 0.1–13.2) EMLA group patient experienced post‐procedure emesis.ConclusionThere is no significant difference between EMLA and N2O in reducing the pain associated with IV cannulation/venipuncture in children in the ED. Both methods are associated with high levels of parental satisfaction. Prolonged EMLA onset time and N2O adverse events may influence the choice of method.

The analgesic efficacy of lidocaine/prilocaine (EMLA) cream during fine-needle aspiration biopsy of thyroid nodules

Summary Objective Pain is one of the few drawbacks of fine-needle aspiration biopsy (FNAB) in patients with nodular thyroid disease (NTD). Lidocaine/prilocaine cream, an eutectic mixture of local anaesthetics (EMLA), is a frequently used topical anaesthetic. Despite its well-documented efficacy for the relief of pain associated with other cutaneous procedures that involve needle insertion, the analgesic role of EMLA has not been previously reported in patients with NTD who are undergoing FNAB. The aim of this study was to determine the analgesic efficacy of EMLA for FNAB-associated pain in patients with NTD. Design Double-blind, placebo-controlled clinical trial. Patients The study was conducted at a thyroid outpatient clinic. We studied 99 patients with NTD. Measurements Patients with NTD were allocated to receive either 2·5 g of EMLA (n = 50) or placebo (n = 49) 60 min before ultrasonographically guided FNAB. A series of four biopsies of each nodule was performed. Patients rated pain associated with the procedure according to a 100-mm visual analogue scale (VAS), an 11-point numeric rating scale (NRS), and 4-category verbal rating scale (VRS). Results When the EMLA group was compared with the placebo group, there were no significant differences with respect to age, sex, thyroid volume, nodule size or nodule site. Significant differences were noted in the pain ratings of the two groups according to all three pain scales. When the effectiveness of EMLA was compared with that of placebo, the mean VAS score was 25·0 ± 22·3 mm vs. 40·0 ± 30·5 mm (P = 0·006) and the mean NRS score was 2·9 ± 2·3 points vs. 4·0 ± 2·6 points (P = 0·02). The absolute numbers according to VRS score in each group was also significantly different (P = 0·01). Although our sample size was small, the data suggest that FNAB-associated pain was sex-related and that women were significantly more sensitive than were men (P = 0·003 for VAS score and P = 0·001 for NRS score). No adverse effects from the use of EMLA were reported. Conclusions To our knowledge, this is the first study demonstrating that a topical anaesthetic, EMLA, provides an effective and noninvasive analgesia during the FNAB of NTD.