Use Of EMLA Cream Research Articles

The use of EMLA cream and 1% lidocaine infiltration in men for relief of pain associated with the removal of genital warts by cryotherapy

Background: Surgical procedures used to remove genital warts (cryotherapy, electrodesiccation) are painful. Attempts to reduce the discomfort of surgery by prior lidocaine infiltration anesthesia are compromised by the pain of the infiltration. Objective: Our purpose was to determine the efficacy of topically applied lidocaine/prilocaine cream to reduce the pain of lidocaine infiltration and the pain associated with cryotherapy to remove genital warts. Methods: Men, scheduled for removal of genital warts by cryotherapy, were randomly selected to receive one of three treatments: (1) lidocaine/prilocaine cream application, (2) 1% lidocaine infiltration, and (3) lidocaine/prilocaine cream application followed by infiltration of 1% lidocaine. Results: Application of lidocaine/prilocaine cream for 15 minutes markedly reduced the pain of lidocaine infiltration. The combination of lidocaine/prilocaine cream followed by infiltration of 1% lidocaine gave greater pain relief from the cryotherapy than did either anesthetic alone. Conclusion: The application of lidocaine/prilocaine cream as an adjunct to lidocaine infiltration reduced the pain of infiltration and the pain associated with cryotherapy for the removal of genital warts. (J Am Acad Dermatol 1997; 37:96–100.)

EMLA Cream as a Topical Anesthetic Before Office Phlebotomy in Children

We studied the effectiveness of EMLA cream (2.5% lidocaine, 2.5% prilocaine) in reducing distress, anxiety, and pain associated with phlebotomy in pediatric outpatients. This was a randomized, double-blind, placebo-controlled study using EMLA cream or placebo 1 hour before phlebotomy. Distress, anticipatory anxiety, pain, and adverse reactions were measured. Measurements of distress and ease of procedure, as well as changes in heart rate, showed significant improvement with EMLA cream as compared with placebo. Pain was decreased with use of EMLA cream. Anticipatory anxiety levels were equal within both groups. Ratings of cream efficacy by parent/observer scales were in favor of EMLA cream.

Use of EMLA cream in the treatment of post-herpetic neuralgia

EMLA cream is an acronym for eutectic mixture of local anesthetics. It contains lidocaine and prilocaine creams. A eutectic preparation, applied topically, penetrates into the dermis after an application period of 1 to 2 hours. This case report describes the successful treatment with EMLA cream of post-herpetic neuralgia, which was resistant to other modes of therapy, and briefly discusses the pharmacology of EMLA cream.

EMLA cream on the ears—is it effective? A prospective, randomised controlled trial of the efficacy of topical anaesthetic cream in reducing the pain of local anaesthetic infiltration for prominent ear correction

A prospective, randomised, double blind trial was carried out to test whether or not the application of topical anaesthetic cream (EMLA cream) before infiltration of local anaesthetic would decrease the discomfort of correction of prominent ears under local anaesthetic. 23 patients were entered into the trial. They acted as their own controls, one ear having EMLA cream applied approximately 2 h prior to surgery, and the other Aqueous cream. Immediately after surgery, the patients were asked to complete two scales describing the amount of pain they had felt in each ear, both at the time of injection of local anaesthetic and during the surgery. They were also asked whether they thought the inconvenience associated with the use of the EMLA cream was worth any improvement they felt. The results showed that, compared to the placebo cream, EMLA cream significantly decreased the pain felt both at the time of injection (p < 0.005) and during the surgery (p < 0.01). However, only 62% of patients asked felt that the inconvenience associated with the use of EMLA cream was worth the benefits that it conveyed.

Trial of a topically administered local anesthetic (EMLA cream) for pain relief during central venous port accesses in children with cancer

Procedure-related pain is a significant problem for many children receiving cytotoxic chemotherapy. In an effort to lessen this toxicity, we studied the efficacy and safety of administering topical local anesthesia using EMLA cream in 47 evaluable children with cancer undergoing implanted central venous port injections. Children (< 21 years old) scheduled to undergo repeated venous access procedures were selected for study. A placebo-controlled, randomized, double-blind, crossover study design was utilized. Statistically significant decreases in pain intensity scores (P < 0.002) were recorded by both children and investigators during the use of EMLA cream as compared with placebo. There was a good correlation between pain scores recorded by both patients and health care providers using both visual analog scales and categorized pain measurement tools. The topical application of EMLA cream 5% provides highly effective superficial anesthesia, and promises to be extremely useful for pain relief during percutaneous access procedures in cancer patients.

The use of EMLA cream to reduce and/or eliminate procedural pain in children.

S ADVOCATES for children, health care proA fessionals are obligated to minimize the emotional and physical effects of these painful procedures. One way in which we can minimize these effects is with the use of EMLAB Cream (ASTRA USA, Inc, Westborough, MA). EMLA@ (Eutectic Mixture of Local Anesthetics), a new product that has been found to be an effective means of decreasing some procedural pain in the majority of children. A fourth-phase efficacy trial of EMLA@ cream was conducted earlier this year which included 8,000 children at over 100 sites nationwide. EMLA@ cream was released for use nationally April 8, 1993. EMLA@ cream is a eutectic (i.e., easily melted or dissolved) mixture of 2.5% lidocaine and 2.5% prilocaine. When applied to normal intact skin under an occlusive dressing, EMLAB provides derma1 analgesia by releasing lidocaine and prilocaine from the cream into the epidermal and dermal layers of the skin. This product is proven to be effective and safe for use in adults and in children 1 month of age and older. EMLA@ cream is supplied in a 5-g tube that contains enough cream to provide anesthesia for two application sites. It is recommended that two sites be prepared in case the first procedure is unsuccessful and a second site is needed. The cream is applied to intact skin in a “dollop” or mounded fashion directly from the tube. This allows for greater absorption of the lidocaine and prilocaine. The EMLAB cream is then covered with an occlu-

Use of EMLA cream for skin anaesthesia prior to epidural insertion in labour

The efficacy of the use of EMLA cream to provide skin anaesthesia prior to the insertion of 16 G Tuohy needles was assessed. Sixty women in labour were randomly allocated to receive either EMLA cream over the proposed epidural site for a minimum period of 5 min (mean 9.1 min), a skin bleb and subcutaneous injection of lignocaine 2% (1 ml), or a skin bleb with additional lignocaine 2% (2 ml) infiltrated into the supra- and interspinous ligaments using a 23 G needle. Once the epidural catheter was sited, using a standard technique, 10 cm visual analogue pain scales were completed independently by the patient, by a blinded midwife and by the anaesthetist siting the epidural. Patients' perception of pain was not significantly different in any of the three groups, although the mean pain score was least in the group receiving full infiltration. The anaesthetists consistently underestimated the patients' perception of pain.

Etude clinique de la crème anesthésique EMLA en anesthésie locorégionale pédiatrique

The advantage of EMLA cream for regional blocks (spinal or caudal blocks) was assessed in 46 children. The study included three groups : group 1, with 1 to 6 month-old children (n = 11) ; group 2, with children aged between 6 months and 5 years (n = 21), scheduled for emergency surgery and with full stomach ; group 3, with 5 to 10 year-old children (n = 14), who were to have a regional block as an alternative to general anaesthesia. The cream was applied as a thick layer on the area of skin to be anaesthetised and covered by a closed adhesive dressing, approximately 2.2 h before performing the regional block. A dose of 1 to 2 g was used in children of more than 1 year, and 0.5 to 1 g for those of less than 1 year. All the blocks were carried out by the same anaesthetist. The technique was considered as being little (45/46) or not constraining (1/46). Patient cooperation in carrying out the regional block was judged to be good or very good in 34/46 children. Additional sedation was required in 7 children of groups 2 and 3. The block was as easy to carry out as usual in 37/46 children. In all threen groups, most children complained of little or no pain. Local adverse effects occurred in 19/46 patients, consisting of erythema (14), skin paleness (4), or both (1). The investigator qualified the use of EMLA cream as satisfactory or very satisfactory in 36/46. It is concluded that EMLA cream provides convenient analgesia for regional blocks in toddlers and children.

Use of EMLA cream as an analgesic in the management of painful otitis externa

A new application of EMLA cream is described. Relief of pain in otitis externa is difficult and systemic analgesics for this localized condition are often ineffective. Meticulous cleaning of the external auditory meatus is an essential step in the treatment. EMLA cream is an effective analgesic which can be used to relieve pain and anaesthetize the external auditory meatus to allow cleaning in patients with intact tympanic membranes.

Topical Skin Anesthesia for Venous, Subcutaneous Drug Reservoir and Lumbar Punctures in Children

A new topical anesthetic ointment (EMLA, "eutectic mixture of prilocaine and lidocaine was studied in a double-blind, placebo-controlled trial to evaluate its efficiency in alleviating pain associated with venous, subcutaneous drug reservoir and lumbar punctures in children. Pain intensity was scored by the children themselves, using a visual analogue scale in which 0 corresponded to absence of sensation and 10 to the worst imaginable painful sensation. Venipunctures were performed on 18 children (6.1 to 12.2 years of age) equally divided in the study and control groups; EMLA cream was associated with lesser pain scores than those with placebo (means +/- SD: 2.8 +/- 2.4 vs 6.8 +/- 2.1, P less than .01). A crossover trial was used in the studies of subcutaneous drug reservoir and lumbar punctures, eight children (6.1 to 15.1 years of age) were tested for subcutaneous drug reservoir punctures; pain induced by this procedure was rated at 3.9 +/- 2.2 with placebo compared with 1.2 +/- 1.8 with EMLA cream (P less than .04). In lumbar punctures (14 children studied, 5.5 to 15.3 years of age), EMLA cream was again associated with less pain (1.9 +/- 1.9) than was placebo (5.6 +/- 3.0, P less than .01). It was concluded that the use of EMLA cream substantially reduces pain caused by venous, subcutaneous drug reservoir, and lumbar punctures in children and may therefore be offered to young patients, particularly those repeatedly submitted to such procedures.

Use of a lignocaine-prilocaine cream as an analgesic in dye laser treatment of port-wine stains

A eutectic mixture of two local anaesthetics—prilocaine and lignocaine (EMLA cream)—has been investigated for its usefulness as an analgesic in the treatment of facial port-wine stains with the tunable dye laser. The cream provided adequate analgesia in eight of 10 patients assessed and was well tolerated. The results of treatment after use of EMLA cream were no different from those where conventional analgesia had been used, and EMLA cream can be recommended for analgesia during laser treatment of port-wine stains.