Use Of EMLA Cream Research Articles

Evaluation of EMLA cream with microneedle patches in palatal anesthesia in children: a randomized controlled clinical trial

Palatal injections are considered to be one of the most painful dental procedures. As a result, it was important to find alternatives to this painful injection to improve children's cooperation. The dental literature mentioned using EMLA cream as a possible alternative to conventional injections, but its anesthetic effect was debated. Therefore, it was valuable to research the impact of microneedle patches to enhance the effectiveness of this cream. The purpose of this randomized controlled clinical trial was to compare the effectiveness of different methods of anesthesia and pain levels in children aged 7–11 years. The study compared the use of EMLA cream, EMLA with microneedles, and conventional palatal injections. A total of 90 children were randomly assigned to three groups: Group 1 received conventional palatal anesthesia (control), Group 2 received EMLA cream only, and Group 3 received EMLA with microneedles. Pain levels were assessed using the FLACC and Wong-Baker scales at three different time points: T1(during anesthesia), T2(on palatal probing), and T3(during extraction). The FLACC scale revealed a significant difference in pain between groups only at T1 (P value = 0.000). It was found that the conventional palatal injection group had a higher pain level than the EMLA cream-only group and the group using microneedle patches with EMLA cream (P value = 0.000). However, the other groups did not show significant differences in pain levels during the anesthesia (P value = 1.00). Similarly, the Wong-Baker scale also demonstrated a statistically significant difference in pain between groups only at T1 (P value = 0.000). It was found that the conventional palatal injection group had a higher pain level than the EMLA cream-only group and the group using microneedle patches with EMLA cream (P value = 0.000). However, the other groups did not show significant differences in pain levels during the anesthesia (P value = 0.091). The study concludes that both EMLA cream alone and EMLA with microneedles can be used as an alternative to conventional palatal anesthesia for children.

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

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

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

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

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

Background:Pain relief of epidural anesthesia in cesarean delivery is difficult. EMLA, a eutectic mixture of lidocaine and prilocaine, is effective for pain reduction during venipuncture and superficial surgery. However, its effectiveness during epidural insertion is not well elucidated. The aim of this randomized, double-blind study was to evaluate the efficacy of EMLA for epidural insertion in elective cesarean delivery.Methods:With Institutional Review Board approval and written patients’ informed consent, forty-two ASA physical status 2 patients (aged 23–45) scheduled for elective cesarean section were included in this study. The patients were randomized to applied ELMA (EMLA group) or placebo cream (Placebo group) about one hour prior to anesthesia. Pain during skin infiltration with 1% mepivacaine and subsequent insertion of Tuohy needle was assessed immediately after each procedure. The presence of patient's response with physical withdrawal on both procedures was recorded. Statistical analysis was performed using Mann–Whitney U test and Fisher's exact test. A value of P < 0.05 was considered significant.Results:Median VAS values on skin infiltration and on insertion of Tuohy needle did not differ between groups. The incidence of patient's response with physical withdrawal on skin infiltration was not different between groups. However, that on insertion of Tuohy needle was significantly lower in EMLA group than in Placebo group (0%, 21%).Conclusions:EMLA cream could not reduce the pain during epidural insertion.

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

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

Meta-analysis of pain control tools in children

Background and Aim: There are several tools for pain controlling in children, but the priority of using tools in different conditions is still unknown to many researchers. Therefore, this study aimed to review the tools used to control pain in children. Materials and Methods: All of the studies done in the All of The world (from 2007-2017) using the words of pain control tools, pain control, pain instruments, pain in children and children's pain measuring instruments from the country's databases, including Magiran, MEDLIB, SID and Iranmedex as well as Latin databases such as Pubmed, scopus and scincedirect were reviewed and data were analyzed using meta-analysis. Results: Out of 200 articles reviewed in the field of pain control tools in children, 125 original articles were reviewed Who had Inclusion criteria entered the study. The most commonly used pain control tools were Distraction, EMLA Cream, Cooling spray, Skin massage, Local anesthetic, Buzzy, J-tip. Conclusion: The method of Distraction in many ways and the use of EMLA cream is most used in controlling children's pain, although the use of Cooling sprays, Skin massage and Local anesthetic are also acceptable methods for controlling child pain

A Comparative Study on the Effect of EMLA Cream and Diclofenac Gel on Pain Caused by Needle Port Placement in Patients Under Chemotherapy: A Clinical Trial

Background: Injections are common nursing interventions, which usually cause pain. The pain caused by injection causes anxiety, discomfort, and reduced patient confidence in nursing performance. Since applying methods that enhance patients’ comfort is a nursing task, the aim of this study was to determine the effect of EMLA cream and diclofenac gel on pain caused by needle port placement in patients undergoing chemotherapy at the oncology department. Methods: This cross-sectional clinical trial study was conducted on 40 inpatients of the Oncology Ward of Khatam-al-Anbia Hospital in Zahedan, during year 2017. Patients were selected by conventional sampling, based on the Inclusion criteria of the study. Patients were randomly assigned to use EMLA cream, diclofenac gel or the placebo. The severity of pain was measured immediately after injection, using the visual analogue scale (VAS). Blindness was done for pain the assessor and data analyzer. The SPSS 22 software was used for statistical analysis. First, descriptive statistics were used to determine the frequency, percentage, and mean, and then inferential statistics of paired t-test, for group comparison. Results: The mean scores of the severity of pain in three groups of EMLA, diclofenac gel, and placebo were 5.49 ± 2.05, 5.88 ± 1.93, and 6.71 ± 1.96, respectively. Comparison between diclofenac gel and placebo showed that the mean decrease in pain intensity in the diclofenac gel group was far more than the placebo (P < 0.0001). Comparing EMLA cream and placebo, the mean reduction in pain intensity in the EMLA cream was far higher than the placebo (P < 0.0001). Finally, the EMLA cream was more effective than diclofenac gel in pain reduction, although the difference was not statically significant. Conclusions: Although the use of EMLA cream and diclofenac gel can reduce pain at the injection site, applying diclofenac gel is recommended due to its availability, cost-effectiveness, and domestic production.

Does the use of EMLA cream (topical lidocaine/prilocaine) decrease the pain of circumcision in newborn boys compared with placebo or dorsal penile nerve block plus lidocaine?

Does the use of EMLA cream (topical lidocaine/prilocaine) decrease the pain of circumcision in newborn boys compared with placebo or dorsal penile nerve block plus lidocaine?

Use of EMLA cream as a topical anaesthetic before venepuncture procedures in field surveys: A practice that helps children, parents and health professionals.

Topical analgesia is becoming essential as the number of invasive screening procedures involving children rises steadily. Little is known about the frequency of these procedures, or about interventions to ease the pain. We investigated the use of EMLA cream in 184 school-aged children in KwaZulu-Natal Province, South Africa. Another group of 20 children did not receive any local analgesia and was assessed as a control. Anticipatory anxiety, pain, adverse reactions and ease of procedure were assessed using a subjective visual analogue scale (VAS) pain score generated by the researcher and obtained from each child immediately after the procedure. The use of EMLA cream resulted in reduced pain and distress. The pain-relieving influence of EMLA was good (91.3% analgesic effect). Participants who received EMLA cream reported significantly lower VAS pain scores (p=0.001). Pain scores generated by the researcher were also significantly lower in the EMLA group than in the control group (p=0.000). No adverse reactions were observed, and the children could continue with other research activities during the application time and after the procedure. Parent or caregiver scores were in favour of EMLA cream. EMLA cream was safe and effective for alleviating the pain associated with venepuncture in a fieldwork setting. We therefore believe that it merits a place in the routine premedication of children before phlebotomy and cannulation procedures in clinical settings, research studies and field surveys. Further research is recommended to assess whether EMLA cream can be used for immunisations.

Leg ulcer progression caused by topical anesthesia with EMLA® cream

While treating a 63-year-old woman with leg ulcerations, we observed an unusual phenomenon. A wound débridement was planned to remove adherent necrotic material. After topical anesthesia with a lidocaine-prilocaine mixture (EMLA cream) a hemorrhagic,livid margin area developed around the ulcer 90 minutes after application. The area turned necrotic over days and the center was débrided. A more detailed history revealed that similar necrosis had occurred previously when EMLA cream had been employed. We interpreted the current event,as well as the past episodes,as a pathological reaction of the small cutaneous blood vessels to EMLA cream. The history also revealed an overlap connective tissue disease with microvascular impairment. After exposure to the topical anesthetics, the pre-damaged cutaneous blood vessels presumably produced a critical ischemia with subsequent necrosis. Based on this case, we recommend careful use of EMLA cream with frequent monitoring for necrosis when treating patients with a known disorder of microcirculation.

Histologic Cutaneous Modifications After the Use of EMLA Cream, A Diagnostic Pitfall: Review of 13 Cases

Histologic Cutaneous Modifications After the Use of EMLA Cream, A Diagnostic Pitfall: Review of 13 Cases

Children's care.

Deputy health minister Lewis Macdonald this month launched an emergency care framework for children and young people in Scotland.

Efficacy of EMLA Cream to Reduce Fear and Pain Associated with Interferon Beta-1a Injection in Patients with Multiple Sclerosis

Fear of pain from injections may affect adherence to needed drug therapy. A single-blind, placebo-controlled crossover study was conducted to evaluate the efficacy of EMLA cream in reducing the fear and pain associated with intramuscular (IM) injection during administration of interferon beta-1a to patients with multiple sclerosis. Patients rated fear of injection on a visual analog scale before the injection and rated injection pain following the injection. With the application of EMLA cream, the mean pain-of-injection score was found to be significantly lower than the mean fear-of-injection score. The 18 patients who completed the study experienced a statistically significant decrease in both scores. This study suggests that the use of EMLA cream may reduce the pain and fear associated with IM injections.

Randomized, double-blind, placebo-controlled prospective study of the efficacy of topical anaesthesia with a eutetic mixture of lignocaine 2·5% and prilocaine 2·5% for topical 5-aminolaevulinic acid-photodynamic therapy for extensive scalp actinic keratos

Photodynamic therapy (PDT) is an effective treatment modality for the treatment of extensive scalp actinic keratoses (AKs), but pain is a significant drawback when treating large areas with topical PDT using 5-aminolaevulinic acid (ALA) as sensitizer. A recent study has shown that use of tetracaine gel (Ametop) did not significantly reduce pain associated with PDT. To assess the benefit of a eutetic mixture of lignocaine 2.5% and prilocaine 2.5% (Emla) on pain during topical ALA-PDT treatment of scalp AKs. Fourteen men aged 59-83 years with extensive scalp AKs were recruited into a double-blind placebo-controlled study. Two treatment fields were defined (right and left frontal scalp) and were treated 2 weeks apart. These fields were randomized to receive either Emla or Aqueous cream as first or second treatment. ALA 20% cream was applied for 4 h. Topical anaesthesia or Aqueous cream was applied for 2 h. Pain was assessed using a visual analogue scale (0-100 mm) at 3, 6, 12 and 16 min. The instrument used for this was a blinded counter with one side reading 'no pain' to 'worst pain ever' with a numerical scale (0-100) on the reverse side. Pain scores were assessed looking at median and interquartile range and confidence intervals and calculating differences between treatment groups and analysing them using a paired t-test. Thirteen patients received treatment to both fields. No significant difference in mean pain scores was seen with the use of Emla cream compared with placebo during treatment of scalp AKs (P = 0.328). There was no significant difference in requirement for oral analgesia following PDT between the two groups (P = 0.06). Our data do not support the routine use of topical anaesthesia with Emla for topical PDT.

Use of EMLA cream with vasectomy

Objectives. To determine whether the application of a eutectic mixture of anesthetic cream (EMLA cream) can decrease the pain of lidocaine injection during vasectomy. Methods. A double-blind, prospective study was performed in which each patient acted as his own control. One hour before a double-incision vasectomy, EMLA cream was applied to one side of the scrotum and a white lanolin hand cream to the other side. A double-incision vasectomy was performed, and each patient was asked to rate the pain associated with each side of the procedure. Results. Eighty-nine patients agreed to the study; 61 patients thought the EMLA cream decreased the pain of the vasectomy, 16 preferred the lanolin hand cream, and 3 said there was no difference. These results were significant at the 0.0001 level using the Student t test. Conclusions. EMLA cream significantly decreases the pain associated with lidocaine injections given as local anesthesia for vasectomy.

Intraoral Use of EMLA Cream for Fiberoptic Intubation

Awake, fiberoptic intubation is a valuable approach to the difficult airway in the ED, but topical anesthesia can be difficult to achieve. Researchers

Pediatric registered nurse usage and perception of EMLA.

Pediatric nurses do not consistently use the anesthetic cream for children. This study examined availability, use, and perception of driving and restraining forces for use of EMLA cream for venipuncture and i.v. catheter insertion. In this descriptive study, surveys were sent to 400 randomly selected pediatric RNs. Surveys were returned by 211 nurses from 36 states. Driving forces for EMLA usage included ease of use and increased patient rapport. Restraining forces were focused on barriers to accessing EMLA. Positive perceptions of EMLA were affected by ease of accessibility. Use of EMLA may be enhanced by standard orders, inservice instruction, and stocking EMLA on the patient care unit.

Topical use of local anesthetics in neonates.

Various local anesthetics as in lidocaine ointment, amethocaine cream and EMLA cream are used topically for minor invasive interventions, such as venipuncture, both in children and adults. Since neonates have a nervous system that, albeit immature, enables them to feel pain, analgesia for these procedures is also indicated. Several studies in neonates have been carried out to establish effectiveness and safety of topically applied local anesthetics. These studies are reviewed in order to assess effectiveness and safety. A Medline search was made in order to review all studies on effectiveness and safety of topical use of local anesthetics in neonates. Effectivity or safety studies using local anesthetics for circumcision were rejected. Seven studies on effectiveness were found: Three studies examined lidocaine ointment and four examined EMLA cream. Effectiveness of lidocaine ointment was questionable in two studies and negative in one. Effectiveness of EMLA cream was positive in two studies and negative in the other two. Four studies were found on safety of EMLA cream. All studies indicated that use of EMLA cream was safe. The poor effectiveness found in the reviewed studies is possibly due to too long an application time, a lipophilic carrier used and difficulties in assessing pain. The time of application is often based upon studies in children. Since the skin of neonates acts more as a mucosa than as mature skin the local anesthetics are able to cross this barrier more rapidly. Also a high bloodflow in the heel enhances the uptake of the drug. The application time in neonates should therefore be reduced compared to children. The use of a lipophilic carrier should be avoided since a lipophilic carrier impedes the local anesthetic to be absorbed, leading to reduced effect. Various methods of pain assessment were being used. Since not all methods used are validated it is difficult to obtain an objective end point. The articles reviewed are non conclusive in their results of effective analgesia. Due to a lipophilic base form and a hydrophilic matrix EMLA cream is most effective. An application time of 30 minutes is recommended. In spite of the present precautions due to fear of methemoglobinemia, use of EMLA cream proved to be safe when used once a day. Since the clinical situation often requires more than one application a day, more research is needed to establish a safe and effective local anesthetic which can be applied topically several times a day in the neonate.

Methaemoglobin formation after the use of EMLA cream in term neonates

EMLA cream 5% (a eutectic mixture of lidocaine and prilocaine) is a topical anaesthetic that has become widely used to minimize pain from venipuncture in children. It has not, however, been recommended in neonates owing to the potential risk of methaemoglobinaemia induced by prilocaine. The aim of this study was to establish the safety of 1 g EMLA cream 5% used on intact skin in term neonates. Forty‐seven neonates, aged 0‐3 months, with a postconceptual age of ≥37 weeks and a body weight between 2.8 and 5.7 kg, were included in a double‐blind, randomized, placebo‐controlled study. After baseline observations a total dose of 1.0 g EMLA/placebo was applied to two sites (0.5 g site−1) for 60‐70 min. Venous methaemoglobin (metHb) levels were determined in each patient at baseline and at three randomly assigned times, 0.5‐18h after application. Following application of the cream, the mean metHb levels were 1.17% (range 0.50‐2.53) in the EMLA group and 0.96% (range 0.50‐1.53) in the placebo group. The metHb concentrations were significantly higher in the EMLA group in the intervals from 3.5 to 13 h after application than in the placebo group, but were well below potentially harmful levels. Based on these results, a 1‐h application of 1 g EMLA cream is safe when used on the intact skin of term neonates below 3 months of age.

Use of EMLA as an adjunct for burning pain associated with a liposarcoma

Objective. To report the successful use of EMLA cream (a topical anesthetic) for the relief of neuro pathic pain in a patient with a liposarcoma. Case Summary. A 63-year-old male with a lipo sarcoma was admitted to the hospital to establish an effective pain control regimen. Despite the use of high-dose hydromorphone, dexamethasone, and in domethacin, he still complained of a burning sensa tion in the skin over the tumor site. EMLA—applied regularly every 8 hours, was started, and within 24 hours the patient reported relief from this pain. Discussion. While there is some experience with the use of systemically administered anesthetics for the control of neuropathic pain in cancer patients, there is little reported experience of the use of topical anesthetics. EMLA has, however, been successfully used for postherpetic neuralgia. Adverse reactions from its use for reducing the pain of venipuncture are usually mild and transient, and repeated use does not appear to increase the risk of toxicity. In this case, the patient's pain was well-controlled without any observ able adverse reactions. Summary. This patient experienced relief of burning pain when EMLA was added to his treatment regimen. EMLA cream could be considered as a treatment option for cancer patients experiencing neuropathic pain, but the patients most likely to benefit and the optimal treatment regimen have yet to be determined by a prospective study.