Local Cream Research Articles

Caudal epidural block versus other methods of postoperative pain relief for circumcision in boys.

Techniques to minimize the postoperative discomfort of penile surgery, such as circumcision, include caudal block; penile block; systemic opioids and topical local anaesthetic cream, emulsion or gel. To compare the effects of caudal epidural analgesia with other forms of postoperative analgesia following circumcision in boys. We searched CENTRAL (The Cochrane Library 2008, Issue 1), MEDLINE (to April 2008) and EMBASE (to April 2008). Randomized and quasi-randomized trials of postoperative analgesia by caudal epidural block compared with non-caudal analgesia in boys, aged between 28 days and 16 years, having elective surgery for circumcision. Two review authors independently carried out assessment of study eligibility, data extraction and assessment of the risk of bias in included studies. We included 10 trials involving 721 boys. No difference was seen between caudal and parenteral analgesia in the need for rescue or other analgesia (relative risk (RR) 0.41, 95% confidence interval (CI) 0.12 to 1.43; 4 trials, 235 boys; random-effects model) or on the incidence of nausea and vomiting (RR 0.61, 95% CI 0.36 to 1.05; 4 trials, 235 boys). No difference in the need for rescue or other analgesia was seen for caudal compared with dorsal nerve penile block (DNPB) (RR 1.25, 95% CI 0.64 to 2.44; 4 trials, 336 boys; random-effects model). No differences were seen between caudal block and DNPB in the incidence of nausea and vomiting (RR 1.88, 95% CI 0.70 to 5.04; 4 trials, 334 boys; random effects model) or individual complications except for motor block (RR 17.00, 95% CI 1.01 to 286.82; 1 trial, 100 boys) and motor or leg weakness (RR 10.67, 95% CI 1.32 to 86.09; 2 trials, 107 boys). These were significantly more common in the caudal block groups than with DNPB. No differences were seen between caudal and rectal or intravenous analgesia in the need for rescue analgesia or any other outcomes (2 trials, 162 boys). Differences in the need for rescue or other analgesia could not be detected between caudal, parenteral and penile block methods. In day-case surgery, penile block may be preferable to caudal block in children old enough to walk due to the possibility of temporary leg weakness after caudal block. Evidence from trials is limited by small numbers and poor methodology. There is a need for properly designed trials comparing caudal epidural block with other methods such as morphine, simple analgesics and topical local anaesthetic creams, emulsions or gels.

Evaluation of dressings used with local anaesthetic cream and for peripheral venous cannulation

To compare four polyurethane dressings manufactured by two different companies for use in children. Seventy-eight dressings were applied to secure either local anaesthetic creams (n = 62) or intravenous cannulae (n = 16). Each dressing was evaluated for ease of application, security and ease of removal, using a simple scoring system. 84 per cent of Opsite flexigrid and 90 per cent of Tegaderm local anaesthetic cream dressings were rated as easy or very easy to apply. Opsite flexigrid was felt to be more secure, whereas Tegaderm was easier to remove. The Tegaderm cannula dressing was easier to apply than the iv3000 dressing. There was little difference between the two brands, including costs.

Evaluation of dressings used with local anaesthetic cream and for peripheral venous cannulation

Evaluation of dressings used with local anaesthetic cream and for peripheral venous cannulation

Local Anaesthetic Cream (EMAL®) for Excacerbation of Pain in Trigeminal Neuralgia

Local Anaesthetic Cream (EMAL®) for Excacerbation of Pain in Trigeminal Neuralgia

Transient hyperaemic response to assess vascular reactivity of skin: effect of topical anaesthesia

BackgroundLocal anaesthetics affect blood vessels in various ways, depending upon the site of action and the drug used. There is controversy over the vascular effects of two widely used topical local anaesthetic agents, EMLA® and Ametop®. We used the transient hyperaemic response (THR) to the brief compression of the brachial artery to assess vascular reactivity of forearm skin after application of topical local anaesthesia. MethodsTwenty healthy male volunteers were studied. Forearm blood flow-flux was measured using laser Doppler flowmetry, and the magnitude of the hyperaemic response to brachial artery occlusion for 20 s was recorded. Control cream, EMLA®, or Ametop® were applied and covered with an occlusive dressing for 60 min. Blood flow-flux and the hyperaemic response measurements were then repeated, with the laser Doppler probes sited over the areas of skin to which the local anaesthetic creams had been applied. Measurements were made at 60, 90, and 120 min after the application of the creams. The THR ratio (THRR) was calculated at each time point, defined as the net hyperaemic flow-flux divided by the baseline flow-flux. ResultsAt 60 min, Ametop caused a significantly greater increase in blood flow and decrease in THRR over control than EMLA [net increase of mean blood flow (sd) over control 95 (61) vs 2 (17) AU (P<0.001), net mean THRR decrease over control 1.33 (1.85) vs −0.34 (1.33) (P<0.02)]. ConclusionsThe application of topical Ametop decreases microvascular tone and vasoreactivity of the forearm skin in healthy volunteers.

555: Local Anaesthetic Cream (EMAL®) for Excacerbation of Pain in Trigeminal Neuralgia

555: Local Anaesthetic Cream (EMAL®) for Excacerbation of Pain in Trigeminal Neuralgia

555. Local Anaesthetic Cream (EMAL®) for Excacerbation of Pain in Trigeminal Neuralgia

555. Local Anaesthetic Cream (EMAL®) for Excacerbation of Pain in Trigeminal Neuralgia

Can Topical Anesthetic Reduce the Pain Associated with Diagnostic Blocks of the Lumbosacral Spine?: Table 1

To evaluate the effectiveness of a topical local anesthetic cream (5% liposomal lidocaine) in reducing needle-induced pain in patients investigated for suspected zygapophysial (z-joint) or sacroiliac (SI) joint pain. Triple-blinded randomized controlled trial. Setting. Interventional fluoroscopy suite. Eighteen patients presenting with chronic mechanical low back pain. Thirty minutes prior to diagnostic z- or SI joint blocks, equivalent amounts of topical 5% liposomal lidocaine cream was applied to one side of the low back and a placebo cream to the other. The treatment side and injection order were randomized and the patient, injectionist, and data recorder were blinded. The subjects provided numerical rating scores of pain intensity immediately following each phase of the injection (skin penetration, deep, overall). Scores were analyzed with dependent t-tests. The injection associated pain was significantly less during the skin penetration phase on the side of the local anesthetic vs the placebo cream (3.0/10 vs 4.2/10; P = 0.002). No significant differences were found during the deep phase or for the injection procedure overall. Five percent liposomal lidocaine cream significantly reduces the pain associated with the skin penetration phase of lumbosacral diagnostic blocks but does not change the pain associated with the deep phase or the injection procedure overall. Its usefulness for this application is questionable.

Topical Anesthetic Creams

Topical anesthetic creams have positive applications in plastic surgery. For certain procedures, they can replace injected local anesthetics. By replacing injections with a topical cream, the negative effects associated with injections, such as pain, needle anxiety, and edema at the surgical site, are eliminated. A variety of U.S. Food and Drug Administration-approved topical anesthetic creams are available for use; however, much care must be taken when prescribing and administering these drugs, as anesthetic creams compounded in nonstandard doses can result in severe toxicity and death. When used appropriately, topical anesthetic creams can provide a safe and effective alternative to other forms of anesthesia. This article provides an overview of topical anesthetic creams, including availability, composition, safety, and efficacy.

Topical Anesthesia With EMLA does Not Decrease Pain During Vasectomy

Previous studies show conflicting results of the ability of EMLA (eutectic mixture of local anesthetics) to decrease pain during vasectomy. We examined the effectiveness of EMLA cream to decrease pain in patients undergoing bilateral percutaneous no-scalpel vasectomy. A prospective study was performed in which 316 patients used EMLA cream (178) or no topical anesthesia (138) before vasectomy. EMLA cream was applied by patients 1 hour before the scheduled time of surgery. Bilateral percutaneous no-scalpel vasectomy was then performed in the 2 groups with local infiltration of 1% lidocaine into the scrotal wall and vasal sheath. Following the procedure patients were asked to rate their associated pain using a visual analog scale. Statistical analysis was performed using the 2-sided Student t test. Mean patient age was similar in the groups with and without EMLA (39.1 and 39.0 years, respectively). No significant difference in mean visual analog pain scores were noted between the EMLA and control groups (21.5 vs 21.0, p = 0.8). Topical anesthesia with EMLA did not significantly decrease the pain associated with percutaneous vasectomy.

Letters

Pressure ulcers are complex chronic wounds for which no gold standard treatment has yet been established, although guidelines have been developed. At present, treatment involves assessment, reduction of pressure, friction and shear forces, optimising local wound care, debridement of necrotic tissue, managing bacterial contamination and correcting nutritional deficits.1 In addition, electrical stimulation, ultraviolet irradiation and local ointments including silver sulphadiazine, neomycin, polymixin and phenytoin have been applied, with varying results.

Local Anesthetic Cream Prepared from Lidocaine-Tetracaine Eutectic Mixture

Local anesthetic creams for the clinical treatment of conditions such as postherpetic neuralgia were prepared as an in-house formulation from the eutectic mixture of lidocaine-tetracaine (LT cream) using two eutectic mixtures of local anesthetic (EMLA) type bases. The LT formulation was compared with a lidocaine-prilocaine (LP cream) eutectic mixture formulated using the same base as EMLA. The chemical stability of lidocaine was examined in advance and was found to be stable for more than 3 months either in LT cream or in LP cream. The release rate of lidocaine from the formulated creams was examined using a cellulose ester membrane. The release rate of lidocaine from LT cream was similar to that from LP cream. The release rate of tetracaine was slightly slower than that of lidocaine in LT cream reflecting the larger molecular size of tetracaine. The penetration rate was examined in vitro using a Yucatan micropig skin. The penetration rate of lidocaine was similar between LT and LP creams. Infiltration anesthesia action examined in guinea pigs indicated that the difference between the two creams was statistically insignificant. The present study suggests the equivalence of the LT and LP creams as a local anesthetic and the potential of LT cream for clinical use either in the easy formulation or in the low-cost formulation.

What do men with premature ejaculation prefer: daily or on-demand drug treatment?

Since the 1930s various drugs have been used to treat premature ejaculation (PE). Currently, there are two major strategies to treat PE. First, daily treatment (selective serotonin reuptake inhibitors (SSRIs), and clomipramine). Second, on-demand treatment (anesthetic creams, SSRIs, clomipramine, tramadol, PDE-5 inhibitors). According to a meta-analysis of all drug treatment studies, published between 1943 and 2003, daily treatment with 20 mg paroxetine exerts the strongest ejaculation delay, compared to other serotonergic drugs. In contrast, on-demand use of SSRIs, including the new SSRI dapoxetine, exerts only a minimal ejaculation delay. Both daily and on-demand use of SSRIs may give rise to drug-induced side effects, like nausea, fatigue and yawning. Advantages of daily SSRI treatment are 1) the disappearance of side effects after 2-3 weeks of treatment and 2) it does not interfere with the spontaneity of having sex; at each moment of the day ejaculation will be delayed. Disadvantages of on-demand treatment is the likely hood of experiencing side effects at the moment of making love and its negative interference with the spontaneity of having sex. One always has to wait 1-6 hours before ejaculation delay occurs. Despite these disadvantages, pharmaceutical companies are promoting on-demand drugs for the treatment of PE. However, until recently there have been no specific studies investigating which strategy of drug treatment is preferred by men with PE. In 2007, Waldinger et al published the first study of this kind. In this observational questionnaire survey, preferences of different treatment strategies were queried before and after standard efficacy and safety information. The population consisted of a consecutive group of 88 men with lifelong PE who decided for themselves to be seen for rapid ejaculation. The age was 37±11years (mean± SD), range 18-64 years. None of these men was ever treated for PE and 21% used medication that did not affect sexual performance. Of them, 71 (81%) preferred a drug for daily use, 14(16%) a drug on-demand, while three men preferred topical anesthetic cream. Those men who initially preferred daily treatment did not change their view after standard information about efficacy and side effects, while 9 of 17 men who initially preferred on-demand drug treatment had switched their preferences to daily oral drug usage. The most frequently reported argument to prefer daily drug treatment was that this strategy would have the least effects toward the spontaneity of having sex. It was concluded that opposed to agents which must be taken 4-6 hours prior to coitus and with the methods used, this group of Dutch men with lifelong PE favor uninterrupted daily drug treatment to delay ejaculation mainly because daily treatment guarantees no interference with the spontaneity of having sex.

Application of Topical Analgesia in Triage: A Potential for Harm

To reduce the overall time spent in the ED, triage nurses are encouraged to treat patients with a topical anesthetic cream, eutectic mixture of local anesthetics (EMLA®). We present a case in which a 28-day-old neonate who was treated with EMLA® cream in triage developed severe methemoglobinemia 18 hours post admission to the pediatric ward. This case demonstrates that there may be some risks associated with this approach, and that protocols for the use of EMLA® at triage should include not only the indications for its use, but also need to ensure that there is a process to have the EMLA® removed before patient discharge or transfer.

Use of a Topical Anesthetic Cream (EMLA) to Reduce Pain After Hemorrhoidectomy

Use of a Topical Anesthetic Cream (EMLA) to Reduce Pain After Hemorrhoidectomy

The effect of local anaesthetic cream (EMLA®) applied with an occlusive dressing on skin thickness. Does it matter?

The effect of local anaesthetic cream (EMLA®) applied with an occlusive dressing on skin thickness. Does it matter?

Use of a Topical Anesthetic Cream (EMLA) to Reduce Pain After Hemorrhoidectomy

Hemorrhoidectomy usually leads to severe postoperative pain that often causes urinary retention. Topical EMLA cream (lidocaine 2.5% and prilocaine 2.5%) has been used extensively in the clinical setting. This prospective study tested the effectiveness of EMLA cream for postoperative pain control after hemorrhoidectomy. Thirty patients admitted for hemorrhoidectomy were enrolled and randomly assigned into either a control group (n = 15) or EMLA group (n = 15). Postoperatively, the control group received approximately 5 g of neomycin ointment, and the EMLA group received approximately 5 g of EMLA. A visual analog scale (VAS) score was recorded on arrival in the postanesthesia recovery unit (PAR), after 2 hours in the PAR, on the first postoperative evening, and on the first postoperative morning. The requested frequency and dosage of meperidine, the first spontaneous voiding time, the frequency of single urinary catheterization, and a patient satisfaction score were also obtained. The VAS score and frequency and dosage of meperidine injections were significantly lower in the EMLA group than in the control group (P < .01). The voiding time was significantly later in the control group (P = .04). The frequency of single catheterization was significantly lower in the EMLA group than in the control group (P = .03). Patient satisfaction with postoperative pain control was significantly higher in the EMLA group than in the control group (P < .01). No systemic complications were observed. Topical EMLA cream decreased pain intensity and meperidine requests, reduced the frequency of single catheterizations, and improved patient satisfaction with postoperative pain management after hemorrhoidectomy in adults.

Procedural pain guidelines for the newborn in the United Kingdom

To assess the use of analgesia guidelines for newborn infants in the United Kingdom. Postal questionnaire to every neonatal unit in the United Kingdom. A total of 192 of 244 units replied (78.7% response). Most units had a guideline for elective intubation (70%), sedation for ventilation (78%) post-operative pain (when appropriate) (74%). Less prevalent were guidelines for painful minor procedures (35%). Only 33% of units gave a sweet-tasting solution for analgesia before routine painful procedures and 12% used a topical anesthetic cream. Since the last survey in 2000 there has been a modest increased uptake in measures to prevent pain neonatal pain in the United Kingdom, but no pain guideline was present in almost 25% of units and no guideline for routine painful procedures in the majority.

EMLA and Water Immersion Cause Similar Vasodilatation in Replanted Fingers

Skin wrinkling on water immersion is a reliable and simple test of sympathetic innervation. The eutectic mixture of local anesthetic (EMLA) cream has been shown to induce near identical clinical wrinkling scores and reduction in digit blood flow as that following water immersion in people with normal sympathetic innervation. This study was designed to investigate the vasomotor response to EMLA in replanted fingers that had poor sympathetic innervation. Laser Doppler imaging (PeriScan PIM II; Perimed AB, Stockholm, Sweden) was used to detect perfusion changes in the pulps of fourteen replanted fingers before and after 0.5 g of 5% EMLA cream application and water immersion in a 40 degrees C normal saline for 30 min, respectively. Comparisons were made with the contralateral corresponding normal fingers. After water immersion and EMLA application, all of the normal fingers showed a considerable and similar decrease in blood perfusion that demonstrated in the absolute perfusion units (pU) (baseline: 1.57 +/- 0.33 pU, after water-immersion, 1.19 +/- 0.22 pU, P < 0.001; decrease: 23.6 +/- 7.7%, after EMLA application: 1.20 +/- 0.18 pU, P < 0.001; decrease: 22.4 +/- 8.9%). In contrast, all of the replanted fingers showed a statistically significant vasodilatatory response (baseline: 1.20 +/- 0.29 pU, after water-immersion: 1.36 +/- 0.28 pU, P < 0.001; increase: 15.2 +/- 9.1%, after EMLA application: 1.38 +/- 0.27 pU, P < 0.001; increase: 16.8 +/- 9.1%). EMLA and water immersion both cause vasodilatation and no skin wrinkling in replanted fingers. These results imply that intact sympathetic nerve function is required to induce the vasoconstrictive effect of EMLA.

The endoscopic application of eutetic mixture of local anaesthetics cream

The endoscopic application of eutetic mixture of local anaesthetics cream