psd-502 and Pain

Lumbar puncture (LP) is a common invasive procedure, most frequently performed to diagnose infection. Physicians perform LP in newborn infants with the help of an assistant using a strict aseptic technique; it is important to monitor the infant during all the steps of the procedure. Without adequate analgesia, LP can cause considerable pain and discomfort. As newborns have increased sensitivity to pain, it is crucial to adequately manage the procedural pain of LP in this population.. To assess the benefits and harms, including pain, discomfort, and success rate, of any pharmacological intervention during lumbar puncture in newborn infants, compared to placebo, no intervention, non-pharmacological interventions, or other pharmacological interventions.. We searched CENTRAL, PubMed, Embase, and three trial registries in December 2022. We also screened the reference lists of included studies and related systematic reviews for studies not identified by the database searches.. We included randomized controlled trials (RCTs) and quasi-RCTs comparing drugs used for pain management, sedation, or both, during LP. We considered the following drugs suitable for inclusion. • Topical anesthetics (e.g. eutectic mixture of local anesthetics [EMLA], lidocaine) • Opioids (e.g. morphine, fentanyl) • Alpha-2 agonists (e.g. clonidine, dexmedetomidine) • N-Methyl-D-aspartate (NMDA) receptor antagonists (e.g. ketamine) • Other analgesics (e.g. paracetamol) • Sedatives (e.g. benzodiazepines such as midazolam) DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. We used the fixed-effect model with risk ratio (RR) for dichotomous data and mean difference (MD) or standardized mean difference (SMD) for continuous data, with their 95% confidence intervals (CIs). Our main outcomes were successful LP on first attempt, total number of LP attempts, episodes of bradycardia, pain assessed with validated scales, episodes of desaturation, number of episodes of apnea, and number of infants with one or more episodes of apnea. We used the GRADE approach to evaluate the certainty of the evidence.. We included three studies (two RCTs and one quasi-RCT) that enrolled 206 newborns. One study included only term infants. All studies assessed topical treatment versus placebo or no intervention. The topical anesthetics were lidocaine 4%, lidocaine 1%, and EMLA. We identified no completed studies on opioids, non-steroidal anti-inflammatory drugs, alpha-2 agonists, NMDA receptor antagonists, other analgesics, sedatives, or head-to-head comparisons (drug A versus drug B). Based on very low-certainty evidence from one quasi-RCT of 100 LPs in 76 infants, we are unsure if topical anesthetics (lidocaine), compared to no anesthesia, has an effect on the following outcomes. • Successful LP on first attempt (first-attempts success in 48% of LPs in the lidocaine group and 42% of LPs in the control group) • Number of attempts per LP (mean 1.9 attempts, [standard error of the mean 0.2] in the lidocaine group, and mean 2.1 attempts [standard error of the mean 2.1] in the control group) • Episodes of bradycardia (0% of LPs in the lidocaine group and 4% of LPs in the control group) • Episodes of desaturation (0% of LPs in the lidocaine group and 8% of LPs in the control group) • Occurrence of apnea (RR 3.24, 95% CI 0.14 to 77.79; risk difference [RD] 0.02, 95% CI -0.03 to 0.08). Topical anesthetics compared to placebo may reduce pain assessed with the Neonatal Facial Coding System (NFCS) score (SMD -1.00 standard deviation (SD), 95% CI -1.47 to -0.53; I² = 98%; 2 RCTs, 112 infants; low-certainty evidence). No studies in this comparison reported total number of episodes of apnea. We identified three ongoing studies, which will assess the effects of EMLA, lidocaine, and fentanyl. Three studies are awaiting classification.. The evidence is very uncertain about the effect of topical anesthetics (lidocaine) compared to no anesthesia on successful lumbar puncture on first attempt, the number of attempts per lumbar puncture, episodes of bradycardia, episodes of desaturation, and occurrence of apnea. Compared to placebo, topical anesthetics (lidocaine or EMLA) may reduce pain assessed with the NFCS score. One ongoing study will assess the effects of systemic treatment.

Topics: Analgesics; Anesthetics, Local; Apnea; Bradycardia; Fentanyl; Humans; Hypnotics and Sedatives; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Spinal Puncture

Male circumcision (MC) is one of the most common surgical procedures performed on neonates. In the last decades, there have been consistent advances in the understanding of pain mechanisms in newborns, and analgesia has become a fundamental part of neonatal care. MC is still often performed with inappropriate analgesic methods, and there is still great variability among the various centers about surgical and anesthethic techniques to do it. The purpose of this review is to summarize the findings in the literature about pain management and analgesia during newborn MC. We performed a systematic review of neonatal MC studies published in the last 20 years. The most effective technique appeared to be the combination of pharmacological and non-pharmacological methods of analgesia.Conclusion: Combining local anesthesia with non-pharmacological analgesic strategies appears to be effective preventing procedural pain during MC. However, a standardized protocol for analgesia during MC is yet to be determined. Sensorial saturation appeared to help when used in conjunction with the local anesthesia techniques. What is Known: • Male circumcision is a painful procedure and it is frequently performed with inappropriate analgesic methods. • A gold standard practice in analgesia during male circumcision is still lacking and there is a great variability in the modus operandi between centers. What is New: • The combination of RB + EMLA + sucrose appears to be an analgesic strategy superior to other approaches. • We advocate for the integration of sensorial saturation during male circumcision in order to improve the efficacy of current analgesic practices.

Topics: Anesthetics, Local; Circumcision, Male; Humans; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Prilocaine

BACKGROUND The 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 AND METHODS We 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. RESULTS Nine 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. CONCLUSIONS EMLA can reduce pain during the ESWL procedure.

Topics: Analgesia; Analgesics, Opioid; Anesthesia, Local; Anesthetics, Combined; Anesthetics, Local; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Lithotripsy; Pain; Pain Management; Pain Measurement

: media-1vid110.1542/5852339542001PEDS-VA_2018-1173. To determine the efficacy and safety of EMLA in infants <3 months of age requiring venipuncture in comparison with nonpharmacological interventions in terms of pain reduction, change in physiologic variables, and methemoglobinemia.. Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and gray literature were searched from inception to August 2017, without language restrictions.. We selected randomized controlled trials in which researchers compared EMLA with nonpharmacological interventions.. Two reviewers independently performed abstract screening and full-text review, and extracted the data and assessed the risk of bias.. Ten randomized controlled trials (907 infants) were included. EMLA revealed little or no effect in reduction of pain (standardized mean difference: 0.14; 95% confidence interval [CI]: -0.17 to 0.45; 6 trials,. Our results may not be applicable to older infants.. EMLA reveals minimal benefits in terms of reduction of pain due to venipuncture procedure in comparison with placebo and no benefit in comparison with sucrose and/or breastfeeding. Moreover, it produced an elevation in methemoglobin levels and skin blanching.

Topics: Anesthetics, Combined; Humans; Infant; Lidocaine, Prilocaine Drug Combination; Pain; Pain Management; Pain Measurement; Phlebotomy; Skin Diseases; Treatment Outcome

To synthesize the evidence on the most effective medications for the relief of intrauterine device (IUD) insertion-related pain.. Systematic review and network meta-analysis of randomized controlled trials (RCTs).. Not applicable.. Patients undergoing IUD insertion who received different medications for pain relief versus those who received placebo.. Electronic search in the following bibliographic databases: Medline via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and ScienceDirect.. Visual analog scale (VAS) pain score during tenaculum placement, IUD insertion, and 5 to 20 minutes after insertion, the score of easiness of insertion and the need for additional analgesics.. The present review included 38 RCTs (n = 6,314 patients). The network meta-analysis showed that lidocaine-prilocaine cream (genital mucosal application) statistically significantly reduced pain at tenaculum placement compared with placebo (mean difference -2.38; 95% confidence interval, -4.07 to -0.68). In the ranking probability order, lidocaine-prilocaine cream ranked the highest in reducing the pain at tenaculum placement, followed by lidocaine (paracervical). Similarly, lidocaine-prilocaine cream ranked as the highest treatment in pain reduction during IUD insertion, followed by lidocaine (paracervical).. Lidocaine-prilocaine cream is the most effective medication that can be used for IUD insertion-related pain. Other medications are not effective.

Topics: Administration, Intravaginal; Anesthetics, Local; Contraception; Female; Humans; Intrauterine Devices; Lidocaine, Prilocaine Drug Combination; Pain; Pain Measurement; Randomized Controlled Trials as Topic; Treatment Outcome

Randomised controlled trials (RCTs) show that breastfeeding newborn infants during painful procedures reduces pain. Mechanisms are considered to be multifactorial and include sucking, skin-to-skin contact, warmth, rocking, sound and smell of the mother, and possibly endogenous opiates present in the breast milk.. To determine the effect of breastfeeding on procedural pain in infants beyond the neonatal period (first 28 days of life) up to one year of age compared to no intervention, placebo, parental holding, skin-to-skin contact, expressed breast milk, formula milk, bottle feeding, sweet-tasting solutions (e.g. sucrose or glucose), distraction, or other interventions.. We searched the following databases to 18 February 2016: the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library), MEDLINE including In-Process & Other Non-Indexed Citations (OVID), Embase (OVID), PsycINFO (OVID), and CINAHL (EBSCO); the metaRegister of Controlled Trials (mRCT), ClinicalTrials.gov (clinicaltrials.gov), and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) (apps.who.int/trialsearch/) for ongoing trials.. We included RCTs and quasi-RCTs involving infants aged 28 days postnatal to 12 months and receiving breastfeeding while undergoing a painful procedure. Comparators included, but were not limited to, oral administration of water, sweet-tasting solutions, expressed breast or formula milk, no intervention, use of pacifiers, positioning, cuddling, distraction, topical anaesthetics, and skin-to-skin care. Procedures included, but were not limited to: subcutaneous or intramuscular injection, venipuncture, intravenous line insertion, heel lance, and finger lance. We applied no language restrictions.. We used standard methodological procedures expected by Cochrane. Two review authors independently considered trials for inclusion in the review, assessed risk of bias, and extracted data. The main outcome measures were behavioural or physiological indicators and composite pain scores, as well as other clinically important outcomes reported by the authors of included studies. We pooled data for the most comparable outcomes and where data from at least two studies could be included. We used mean difference (MD) with 95% confidence interval (CI), employing a random-effects model for continuous outcomes measured on the same scales. For continuous outcomes measured on different scales, we pooled standardised mean differences (SMDs) and associated 95% CIs. For dichotomous outcomes, we planned to pool events between groups across studies using risk ratios (RRs) and 95% CIs. However, as insufficient studies reported dichotomous outcomes, we did not pool such events. We assessed the evidence using GRADE and created a 'Summary of findings' table.. We included 10 studies with a total of 1066 infants. All studies were conducted during early childhood immunisation. As the breastfeeding intervention cannot be blinded, we rated all studies as being at high risk of bias for blinding of participants and personnel. We assessed nine studies as being at low risk of bias for incomplete outcome data. In addition, we rated nine studies as high risk for blinding of outcome assessment. We scored risk of bias related to random sequence generation, allocation concealment, and selective reporting as unclear for the majority of the studies due to lack of information.Our primary outcome was pain. Breastfeeding reduced behavioural pain responses (cry time and pain scores) during vaccination compared to no treatment, oral water, and other interventions such as cuddling, oral glucose, topical anaesthetic, massage, and vapocoolant. Breastfeeding did not consistently reduce changes in physiological indicators, such as heart rate. We pooled data for duration of cry from six studies (n = 547 infants). Breastfeeding compared to water or no treatment resulted in a 38-second reduction in cry time (MD -38, 95% CI -50 to -26; P < 0.00001). The quality of the evidence according to GRADE for this outcome was moderate, as most infants were 6 months or younger, and outcomes may be different for infants during their 12-month immunisation. We pooled data for pain scores from five studies (n = 310 infants). Breastfeeding was associated with a 1.7-point reduction in standardised pain scores (SMD -1.7, 95% CI -2.2 to -1.3); we considered this evidence to be of moderate quality as data were primarily from infants younger than 6 months of age. We could pool heart rate data following injections for only two studies (n = 186); we considered this evidence to be of low quality due to insufficient data. There were no differences between breastfeeding and control (MD -3.6, -23 to 16).Four of the 10 studies had more than two study arms. Breastfeeding was more effective in reducing crying duration or pain scores during vaccination compared to: 25% dextrose and topical anaesthetic cream (EMLA), vapocoolant, maternal cuddling, and massage.No included studies reported adverse events.. We conclude, based on the 10 studies included in this review, that breastfeeding may help reduce pain during vaccination for infants beyond the neonatal period. Breastfeeding consistently reduced behavioural responses of cry duration and composite pain scores during and following vaccinations. However, there was no evidence that breastfeeding had an effect on physiological responses. No studies included in this review involved populations of hospitalised infants undergoing other skin-breaking procedures. Although it may be possible to extrapolate the review results to this population, further studies of efficacy, feasibility, and acceptability in this population are warranted.

Topics: Anesthetics, Local; Breast Feeding; Crying; Female; Glucose; Heart Rate; Humans; Infant; Infant Care; Lidocaine; Lidocaine, Prilocaine Drug Combination; Massage; Pain; Pain Management; Pain Measurement; Prilocaine; Randomized Controlled Trials as Topic; Time Factors; Vaccination

Topics: Adolescent; Anesthetics, Local; Child; Child, Preschool; Humans; Infant; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Prilocaine; Punctures; Tetracaine

Male circumcision (MC) is one of the oldest and most common operations performed all over the world. It can be performed at different ages, using different surgical techniques, for different religious, cultural and medical reasons.Our aim is to examine and compare the various methods of analgesia and different surgical procedures reported in literature that are applied in infant MC. We performed a PubMed, MEDLINE, EMBASE and Cochrane search in the papers published since 2000: 14 studies met the inclusion criteria, most of them showing that a combined pharmacological and non-pharmacological intervention is the best analgesic option, in particular when the dorsal penile nerve block is combined with other treatments. The Mogen surgical procedure seems to be the less painful surgical intervention, when compared with Gomco clamp or PlastiBell device. Only 3 papers studied groups of at least 20 babies each with the use of validated pain scales. Data show a dramatic decrease of pain with dorsal penile nerve block, plus acetaminophen associated to oral sucrose or topic analgesic cream. However, no procedure has been found to definetively eliminate pain; the gold standard procedure to make MC totally painfree has not yet been established.

Topics: Administration, Cutaneous; Analgesia; Anesthetics, Local; Circumcision, Male; Humans; Infant; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Prilocaine; Treatment Outcome

Venous leg ulcers affect up to 1% of people at some time in their lives and are often painful. The main treatments are compression bandages and dressings. Topical treatments to reduce pain during and between dressing changes are sometimes used.. To determine the effects of topical agents or dressings for pain in venous leg ulcers.. For this third update the following databases were searched: Cochrane Wounds Group Specialised Register (searched 9 May 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 4); Ovid MEDLINE (2009 to April Week 4 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations May 08, 2012); Ovid EMBASE (2009 to 2012 Week 18); and EBSCO CINAHL (2009 to May 2 2012). No date or language restrictions were applied.. Published or unpublished randomised controlled trials (RCTs) that evaluated the effects of topical agents or dressing for the treatment of pain in venous ulcers were included.. Two review authors independently performed trial selection, data extraction and risk of bias assessment.. Six trials (343 participants) evaluated Eutectic Mixture of Local Anaesthetics (EMLA): lidocaine-prilocaine cream for the pain associated with ulcer debridement. The between-group difference in pain measured on a 100 mm scale was statistically significant in favour of EMLA (MD -20.65, 95% CI -12.19 to -29.11). No significant between-group differences in burning or itching were observed.Two trials (470 participants with venous leg ulcers) evaluated ibuprofen slow-release foam dressings for persistent venous leg ulcer pain. Compared with local best practice, significantly more participants in the ibuprofen dressing group achieved the outcome of >50% of the total maximum pain relief score between day 1 and day 5 than participants in the local best practice group (RR 1.63, 95% CI 1.24 to 2.15). The number needed to treat was 6 (95% CI 4 to 12). In the second trial, compared with an identical non-ibuprofen foam dressing, there was no statistically significant difference in the proportion of participants experiencing slight to complete pain relief on the first evening of treatment.Limited data were available to assess healing rates or adverse events.. There is some evidence to suggest that ibuprofen dressings may offer pain relief to people with painful venous leg ulcers. EMLA (5%) appears to provide effective pain relief during the debridement of venous leg ulcers. Further research should consider standardised pain assessment methods and assess both the effect on ulcer healing and the impact of long term use of these treatments.

Topics: Administration, Topical; Analgesics; Anesthetics, Local; Bandages; Debridement; Humans; Ibuprofen; Leg Ulcer; Lidocaine; Lidocaine, Prilocaine Drug Combination; Ointments; Pain; Prilocaine; Randomized Controlled Trials as Topic; Varicose Ulcer

Topics: Anesthetics, Local; Circumcision, Male; Equipment and Supplies; Evidence-Based Medicine; Humans; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Nerve Block; Pacifiers; Pain; Practice Guidelines as Topic; Prilocaine

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.

Topics: Administration, Topical; Anesthetics, Local; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Ointments; Pain; Pain Measurement; Prilocaine; Sensitivity and Specificity; Surgery, Plastic

Children often experience pain from needle insertion procedures; therefore, several topical anaesthetics have been developed.. To compare the topical anaesthetics amethocaine and an eutectic mixture of local anaesthetics (EMLA) in terms of anaesthetic efficacy, ease of needle insertion and adverse events when used for intravenous cannulation and venipuncture in children.. An exhaustive search that included over 30 databases and handsearching reference lists and journals. Language restrictions were not imposed.. Randomized controlled trials were selected that compared EMLA and amethocaine for relieving children's pain from intravenous cannulation or venipuncture.. Two review authors independently determined eligibility for inclusion by assessing trial quality. Details of eligible studies were summarized. One author was contacted for additional information. Information about adverse events was obtained from the text of the trial reports. Review Manager 4.2 was used to perform a meta-analysis and compute relative risks (RR) with 95% confidence intervals.. Six trials consisting of 534 children, three months to 15 years of age, were included in this review. A meta-analysis was done comparing amethocaine with EMLA on anaesthetic efficacy, ease of needle procedure and resultant skin changes. For anaesthetic efficacy, amethocaine significantly reduced the risk of pain compared to EMLA when all pain data were combined into a common pain metric (RR 0.78, 95% CI 0.62 to 0.98); when pain was self-reported by children (RR 0.63, 95% CI 0.45 to 0.87); or when pain was observed by researchers (sensitivity analysis: RR 0.71, 95% CI 0.52 to 0.96). Compared to EMLA, amethocaine significantly reduced the risk of pain when drugs were applied for the following durations: for 30 to 60 minutes (RR 0.61, 95% CI 0.41 to 0.91); when applied according to manufacturer's instructions (sensitivity analysis: RR 0.64, 95% CI 0.46 to 0.89); and when applied for over 60 minutes (RR 0.70, 95% CI 0.51 to 0.96). Amethocaine was also significantly more efficacious than EMLA when used specifically for intravenous cannulation (RR 0.70, 95% CI 0.55 to 0.88). Insufficient data were available to compare anaesthetic efficacy for venipuncture.A comparison of amethocaine and EMLA for ease of a needle procedure was not significant; only one trial reported data that could be included. For skin changes, EMLA was favoured in the analysis of erythema (RR 14.83, 95% CI 2.28 to 96.36). Erythema was observed after use of amethocaine whereas blanching was observed after using EMLA. Adverse effects included itching and one case of conjunctival irritation.. Although EMLA is an effective topical anaesthetic for children, amethocaine is superior in preventing pain associated with needle procedures.

Topics: Adolescent; Anesthetics, Local; Child; Child, Preschool; Humans; Infant; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Prilocaine; Punctures; Tetracaine

Topics: Administration, Cutaneous; Amitriptyline; Anesthetics, Local; Bandages; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Pain Measurement; Patient Selection; Pressure Ulcer; Prilocaine

Topics: Administration, Topical; Anesthetics, Combined; Anesthetics, Local; Animals; Drug Combinations; Drug Evaluation; Drug Tolerance; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Prilocaine; Time Factors; Treatment Outcome

We compare the analgesic efficacy of topical anesthetics for dermal instrumentation with conventional infiltrated local anesthesia and also compare topically available amide and ester agents with a eutectic mixture of local anesthetics (EMLA).. We conducted a systematic review of randomized, controlled trials. Relevant literature was identified through searches of MEDLINE, Cochrane Central Register of Controlled Trials, and the Excerpta Medica Database Drugs and Pharmacology. We limited the type of procedures to puncture of intact skin with a needle. The primary outcome was analgesic efficacy, reflected in the patient's self-report of pain intensity during dermal instrumentation. Where possible, quantitative methods were used to summarize the results.. We identified 25 randomized controlled trials including 2,096 subjects. The results of the trials comparing the efficacy of EMLA with infiltrated local anesthetic were inconsistent. Qualitative analysis demonstrated comparable analgesic efficacy between liposome-encapsulated lidocaine and EMLA. The weighted mean difference in 100-mm visual analogue scale pain scores favored topical tetracaine over EMLA (-8.1 mm; 95% confidence interval -15.6 mm to -0.6 mm). Liposome-encapsulated tetracaine provided greater analgesia than EMLA according to the weighted mean difference in 100-mm visual analogue scale scores (-10.9 mm; 95% confidence interval -15.9 mm to -5.9 mm).. EMLA may be an effective, noninvasive means of analgesia before dermal procedures. However, we identified 3 topical anesthetics that are at least as efficacious as EMLA: tetracaine, liposome-encapsulated tetracaine, and liposome-encapsulated lidocaine. Liposomal lidocaine is commercially available in the United States and offers a more rapid onset and less expensive alternative to EMLA.

Topics: Administration, Cutaneous; Adolescent; Adult; Aged; Aged, 80 and over; Anesthetics, Local; Biopsy, Needle; Catheterization; Child; Child, Preschool; Emergency Medicine; Female; Humans; Injections, Intradermal; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Pain Measurement; Phlebotomy; Prilocaine; Punctures; Randomized Controlled Trials as Topic; Tetracaine; Treatment Outcome

Venipuncture is one of the most painful medical procedures for a child, and it is one of the most frequently performed. This literature synthesis reviews evidence for the use of eutectic mixture of local anesthetics (EMLA) cream to reduce the pain children experience during venipuncture. EMLA cream was compared with placebo, iontophoresis, and amethocaine cream and was found to be an effective local anesthetic for pediatric venipuncture pain during both intravenous cannulation and phlebotomy.

Topics: Anesthetics, Local; Child; Child Welfare; Controlled Clinical Trials as Topic; Humans; Iontophoresis; Lidocaine; Lidocaine, Prilocaine Drug Combination; Ointments; Pain; Pain Measurement; Phlebotomy; Prilocaine; Tetracaine

Circumcision is a painful procedure that many newborn males undergo in the first few days after birth. Interventions are available to reduce pain at circumcision; however, many newborns are circumcised without pain management.. The objective of this review was to assess the effectiveness and safety of interventions for reducing pain at neonatal circumcision.. We searched Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2004), MEDLINE (1966 - April 2004), EMBASE (1988 - 2004 week 19), CINAHL (1982 - May week 1 2004), Dissertation Abstracts (1986 - May 2004), Proceedings of the World Congress on Pain (1993 - 1999), and reference lists of articles. Language restrictions were not imposed.. Randomised controlled trials comparing pain interventions with placebo or no treatment or comparing two active pain interventions in male term or preterm infants undergoing circumcision.. Two independent reviewers assessed trial quality and extracted data. Ten authors were contacted for additional information. Adverse effects information was obtained from the trial reports. For meta-analysis, data on a continuous scale were reported as weighted mean difference (WMD) or, when the units were not compatible, as standardized mean difference.. Thirty-five trials involving 1,984 newborns were included. Thirty-three trials enrolled healthy, full term neonates, and two enrolled infants born preterm. Fourteen trials involving 592 newborns compared dorsal penile nerve block (DPNB) with placebo or no treatment. Compared to placebo/no treatment, DPNB demonstrated significantly lower heart rate [WMD -35 bpm, 95% CI -41 to -30], decreased time crying [WMD -54 %, 95% CI -64 to -44], and increased oxygen saturation [WMD 3.2 %, 95% CI 2.7 to 3.7]. Six trials involving 190 newborns compared eutectic mixture of analgesics (EMLA) with placebo. EMLA demonstrated significantly lower facial action scores [WMD -46.5, 95% CI -80.4 to -12.6], decreased time crying [WMD - 15.8 %, 95% CI -20.8 to -6.8] and lower heart rate [WMD -15 bpm, 95% CI -19 to -10]. DPNB, compared with EMLA in four trials involving 164 newborns, demonstrated significantly lower heart rate [WMD -17 bpm, 95% CI -23 to -11] and pain scores. When compared with sucrose in two trials involving 126 newborns, DPNB demonstrated less time crying [MD -166 s, 95% CI -211 to -121], and lower heart rate [WMD -27 bpm, 95% CI -33 to -20]. Results obtained for trials comparing oral sucrose and oral analgesics to placebo, and trials of environmental modification were either inconsistent or were not significantly different. Adverse effects included gagging, choking, and emesis in placebo/untreated groups. Minor bleeding, swelling and hematoma were reported with DPNB. Erythema and mild skin pallor were observed with the use of EMLA. Methaemoglobin levels were evaluated in two trials of EMLA, and results were within normal limits.. DPNB was the most frequently studied intervention and was the most effective for circumcision pain. Compared to placebo, EMLA was also effective, but was not as effective as DPNB. Both interventions appear to be safe for use in newborns. None of the studied interventions completely eliminated the pain response to circumcision.

Topics: Analgesics; Anesthetics, Local; Circumcision, Male; Humans; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Nerve Block; Pain; Pain, Postoperative; Prilocaine; Randomized Controlled Trials as Topic

Venous leg ulcers affect up to 1 per cent of people at some time in their life. These ulcers are often painful and some clinicians choose dressings and topical treatments (analgesia/ local anaesthetic) to reduce the pain both during and between dressing changes.. To assess the effectiveness of dressings, local anaesthetics or topical analgesia for pain relief in venous leg ulceration.. Cochrane Wounds Group Register and the Cochrane Collaboration Field in Complementary Medicine were searched in June 2002. Cochrane Pain Palliative and Supportive Care Group and Cochrane Wounds Group strategy were combined and used.. All randomised controlled trials which evaluated local interventions used to relieve venous leg ulcer pain were considered. Pain was defined as either persistent pain or pain at dressing changes or debridement.. Eligibility for inclusion was confirmed by two reviewers who independently assessed the potential trials. Details of eligible studies were summarised using a data extraction sheet which was checked by the second reviewer.. No trials evaluating interventions for persistent pain were identified for the initial review in 1999 nor the update in 2002. Three trials were included in the 1999 review comparing a eutectic mixture of local anaesthetic (EMLA) versus placebo for pain at debridement. In 2002 a further 3 trials were available (6 trials in total with 317 patients). The studies were considered sufficiently similar to pool and meta analysis found a statistically significant reduction in debridement pain scores with EMLA 5% cream. EMLA was associated with a reduction in pain scores (measured on a 100 mm scale) of 20.6 mm (95% Confidence Interval 29.11-12.19). One small trial measured healing as an outcome and found no difference in numbers of ulcers healed at the end of the study.. EMLA provides effective pain relief for venous leg ulcer debridement however, the effect of the product on ulcer healing is unknown. Research is required to determine the impact of debridement and of EMLA on ulcer healing. There were no trials addressing the treatment of persistent pain (between and at dressing changes) and further research is warranted.

Topics: Administration, Topical; Anesthetics, Local; Bandages; Debridement; Humans; Leg Ulcer; Lidocaine; Lidocaine, Prilocaine Drug Combination; Ointments; Pain; Prilocaine

Pain can be caused to premature babies when nursing and other procedures are carried out. Procedural pain management for these babies raises challenging questions for health care professionals. Optimal pain management for premature babies can be reached by using and further developing existing pharmacological and non-pharmacological pain alleviation methods for procedural pain before, during, and after procedures.. The aims of this study were to describe the environment of pain management in nursing procedures and examinations with premature babies; to describe preparation of the baby for the procedure; to describe non-pharmacological pain alleviation methods during and after the procedures; and to develop a process describing procedural pain management in premature babies.. The material for this study consisted of journal articles on non-pharmacological procedural pain alleviation in infants published between 1994 and 2002. During this period knowledge of pain management in premature babies has improved considerably. The study was based on the method of content analysis.. Procedural pain management in premature babies was described by researchers as a process comprising: (1) an environment that is favourable to effective pain management, (2) safe preparation of the baby for the procedure, (3) pain alleviation during the procedure, and (4) restoring the baby's sense of security after the procedure. Pain management is recommended to be used alone or together with pharmacological interventions. Additionally, systematic pain management requires documentation of the whole pain management process.. Pain management can be described as a process. It is important to test and assess this process and individual non-pharmacological pain management methods in practical nursing situations. The findings of this review can be used to improve pain management methods in premature babies.

Topics: Anesthetics, Local; Humans; Infant, Newborn; Infant, Premature; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Pain Measurement; Prilocaine

Topics: Administration, Cutaneous; Adult; Anesthetics, Combined; Anesthetics, Local; Child; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Occlusive Dressings; Ointments; Pain; Pain Measurement; Prilocaine; Safety; Treatment Outcome

Topics: Anesthetics, Local; Biopsy; Female; Hemostatic Techniques; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Prilocaine; Vulvar Diseases

Venous leg ulcers affect up to 1 per cent of people at some time in their life. These ulcers are often painful and some clinicians choose dressings to reduce the pain both during and between dressing changes.. To assess the effectiveness of dressings, local anaesthetics/analgesics for pain relief in venous leg ulceration.. Cochrane Wounds Group Register and the Cochrane Collaboration Field in Complementary Medicine were searched. Cochrane Pain Palliative and Supportive Care Group and Cochrane Wounds Group strategy were combined and used.. All randomised controlled trials which evaluated local interventions used to relieve venous leg ulcer pain were considered. Pain was defined as either persistent pain or pain at dressing changes or debridement.. Eligibility for inclusion was confirmed by two reviewers who independently assessed the all potential trials. Details of eligible studies were summarised using a data extraction sheet which was checked by the second reviewer.. No trial evaluated interventions for persistent pain. Three trials compared a eutectic mixture of local anaesthetic (EMLA) versus placebo for pain at debridement. All 3 trials reported a significant difference in pain in favour of EMLA, however, one of the trials favoured placebo in terms of number of ulcers healed at the end of the trial and another trial noted an increased incidence of burning and itching with the use of EMLA.. EMLA may provide pain relief for venous leg ulcer debridement however, the effect of the product on ulcer healing and the incidence of itching and burning is unclear. Research is required to address questions such as the benefits of leg ulcer debridement and the impact of EMLA on healing and the incidence of burning and itching. There were no trials addressing the treatment of persistent pain and further research is warranted.

Topics: Administration, Topical; Anesthetics, Local; Bandages; Humans; Leg Ulcer; Lidocaine; Lidocaine, Prilocaine Drug Combination; Ointments; Pain; Prilocaine

Topics: Administration, Oral; Analgesia; Anesthetics, Combined; Anesthetics, Local; Databases, Bibliographic; Databases, Factual; Evidence-Based Medicine; Glucose; Heel; Humans; Infant, Newborn; Internet; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Prilocaine; Punctures; Randomized Controlled Trials as Topic

Patient satisfaction with nursing care is the strongest predictor of overall satisfaction. Reducing discomfort of routine procedures, such as venipuncture for an intravenous insertion, can contribute to perceived satisfaction. This article reviews three common pharmacological interventions that can be used by perianesthesia nurses to reduce the pain of venipuncture.

Topics: Anesthetics, Local; Ethyl Chloride; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Patient Satisfaction; Perioperative Nursing; Phlebotomy; Prilocaine

Recent research suggests that infants may be more vulnerable to the negative effects of pain than older children and adults. Apart from short-term effects, untreated pain and stressful stimuli may also have long-term effects, which may later affect their neurological development, including the reaction to pain. The preterm neonate is at especially high risk. Despite convincing evidence from recent research of the necessity to treat pain and to avoid early exposure to pain, the neonate is still subjected to painful procedures and even surgery without adequate pain treatment. This inadequacy could be due to insecurity regarding the pharmacokinetics and pharmacodynamics of pain-related drugs, to a limited understanding of the pain behaviour and pain physiology and the lack of appropriate measurement tools. The present paper reviews recent research in relation to management of pain in the newborn and considers implications for practice and future studies.

Topics: Anesthesia, Conduction; Anesthetics, Local; Humans; Infant, Newborn; Infant, Premature; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Pain Management; Pain Measurement; Prilocaine

Topics: Administration, Topical; Anesthetics, Local; Child; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Nurse Practitioners; Pain; Pediatric Nursing; Prilocaine; Time Factors

Neonates routinely undergo painful cutaneous procedures as part of their medical treatment. Lidocaine-prilocaine 5% cream (EMLA) is a topical anesthetic that may be useful for diminishing the pain from these procedures. EMLA is routinely used in children and adults. There is substantial apprehension about its use in neonates because of concerns that it may cause methemoglobinemia. The objective of this review was to determine the efficacy and safety of EMLA as an analgesic for procedural pain treatment in neonates and provide evidence-based recommendations for clinical practice.. Systematic review techniques were used. Studies were identified using manual and computer-aided searches (Medline, EMBASE, Reference Update, personal files, scientific meeting proceedings). Behavioral (eg, facial action, crying) and physiologic (eg, heart rate, oxygen saturation, blood pressure, respiratory rate) outcome data from prospective nonrandomized controlled studies and randomized controlled trials in full-term and preterm neonates were accepted for inclusion to establish efficacy of EMLA. The risk of methemoglobinemia (defined as methemoglobin concentration >5% and requiring medical intervention) was estimated from all prospective studies.. Eleven studies of the efficacy of EMLA were included in the analysis. Infant gestational age at the time of delivery ranged from 26 weeks to full-term. Two studies included data from both neonates and older infants. The following procedures were studied: circumcision (n = 3), heel lancing (n = 4), venipuncture (n = 1), venipuncture and arterial puncture (n = 1), lumbar puncture (n = 1), and percutaneous venous catheter placement (n = 1). Nine studies were randomized controlled trials. The total sample size for each study ranged from 13 to 110 neonates. The dose of EMLA used was 0.5 g to 2 g in 9 studies, and was not specified in the others. The duration of application ranged from 10 minutes to 3 hours. The three studies that investigated the efficacy of EMLA for decreasing the pain of circumcision used a randomized controlled trial design. All of them demonstrated significantly reduced crying time during the procedure in the infants in the EMLA group compared with the infants in the control group. Facial grimacing, assessed in two of the studies, was also significantly lower in the EMLA group. Using meta-analytic techniques, the heart rate outcome data for two studies was summarized. Increases in heart rate compared with baseline values were 12 to 27 beats per minute less for the EMLA group than in the placebo group during various stages of the surgical procedure. Three studies that investigated the pain from heel lancing were randomized controlled trials; the other was a nonrandomized controlled study. None demonstrated a significant benefit of EMLA for any of the outcome measures used to assess pain (ie, behavioral pain scores, infant crying, heart rate, blood pressure, respiratory rate, oxygenation parameters). One randomized controlled study of the pain from venipuncture showed that infants treated with EMLA had significantly lower heart rates and cry duration compared with infants treated with a placebo. In one nonrandomized study, a significantly lower behavioral pain score was observed for infants treated with EMLA compared with the control group. Infant heart rate, however, did not differ between the groups. In one randomized controlled study of pain from percutaneous venous catheter placement, EMLA resulted in a significantly lower increase in heart rate and respiratory rate. Behavioral pain scores were significantly lower during arterial puncture in one nonrandomized controlled study. EMLA did not reduce physiologic changes or behavioral pain sc

Topics: Acute Disease; Analgesia; Anesthetics, Combined; Anesthetics, Local; Child, Preschool; Humans; Infant; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Ointments; Pain; Pain, Postoperative; Prilocaine; Randomized Controlled Trials as Topic; Safety

To consider topical anesthetic options available to primary care physicians, indications for their use, and efficacy and safety of these agents as supported by the literature.. Five randomized controlled trials were retrieved that compared various topical anesthetics as well as topical anesthetics versus infiltrative anesthesia.. A combination of lidocaine, epinephrine, and tetracaine (LET) is currently the topical anesthetic of choice for repair of simple lacerations involving the faces and scalps of children. A promising new topical preparation is bupivacaine and epinephrine, but its efficacy must be studied in larger populations before widespread use can be advocated. Using EMLA (eutectic mixture of local anesthetics) for repair of extremity lacerations requires further study and cannot yet be recommended. Continued use of topical tetracaine, adrenaline, and cocaine (TAC) is not supported in the literature, because of its greater expense, its status as a restricted narcotic, its potential for toxicity, and better availability of an equally efficacious alternative, LET.. Children's simple facial and scalp lacerations can be safely repaired using topical LET gel. Physicians must adhere to recommendations to avoid mucous membrane contact and ensure appropriate dosing with these agents. Bupivacaine-epinephrine topical preparation is a promising analgesic agent that warrants further study.

Topics: Adult; Anesthetics, Combined; Anesthetics, Local; Child; Cocaine; Drug Combinations; Epinephrine; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Patient Selection; Prilocaine; Research Design; Suture Techniques; Tetracaine; Wounds and Injuries

There exists two distinct types of patches aiming at increasing the pain threshold either systematically or locally. The first type of analgesic patch is a real transdermal delivery system releasing fentanyl. Such potent opioid drug exerts a systemic effect. The other type of patch associates lidocain and prilocain to induce a local anesthesia of the skin without inducing a systemic effect.

Topics: Administration, Cutaneous; Analgesics, Opioid; Anesthetics, Local; Fentanyl; Lidocaine; Lidocaine, Prilocaine Drug Combination; Morphine; Pain; Prilocaine; Therapeutic Equivalency

The ideal topical anesthetic agent is one that provides 100% anesthesia in a short period of time, work on intact skin without systemic side effects, and invokes neither pain nor discomfort. The quest to find such an agent continues today. Because a topical anesthetic agent will induce anesthesia painlessly, the need for an effective agent is clear. This will serve to eliminate painful injections with lidocaine prior to many dermatologic procedures.. To provide a review of topical agents used in the past, to present products that are being used today, and to look to the future of topical anesthesia. CONCLUSIVE: During the last three decades a variety of methods have been employed to administer topical anesthesia. Presently, EMLA (eutectic mixture of local anesthetics) is the most often used method among practicing dermatologists. However, iontophoresis and the anesthetic patch are equally effective with a few notable advantages over EMLA. Liposomal agents show promise as we enter into a new millennium.

Topics: Administration, Cutaneous; Adult; Anesthesia, Local; Anesthetics, Local; Child; Dermatologic Surgical Procedures; Drug Carriers; Drug Combinations; Forecasting; Humans; Injections, Subcutaneous; Iontophoresis; Lidocaine; Lidocaine, Prilocaine Drug Combination; Liposomes; Occlusive Dressings; Ointments; Pain; Prilocaine

Management of painful procedures in the neonate is less than optimal. Although evidence exists to support the infant's capacity to feel pain at birth, health professionals do not prescribe or administer adequate analgesia. This is largely because of the lack of published data on the safety and efficacy of pharmacologic interventions and lack of sufficient understanding of the benefits of nonpharmacologic measures. In this review, recent research on the safety and efficacy of pharmacologic and nonpharmacologic interventions for managing painful procedures in the neonate is summarized.

Topics: Analgesics; Analgesics, Non-Narcotic; Analgesics, Opioid; Anesthetics, Local; Drug Combinations; Humans; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Prilocaine

Topics: Acute Disease; Administration, Oral; Analgesia, Epidural; Analgesia, Patient-Controlled; Analgesics; Analgesics, Non-Narcotic; Anesthetics, Local; Child; Child, Preschool; Drug Combinations; Fentanyl; Humans; Infant; Lidocaine; Lidocaine, Prilocaine Drug Combination; Methadone; Pain; Pain Measurement; Prilocaine; Self Administration

To compare the efficacy of a local anesthetic cream and music distraction in reducing or preventing pain from needle puncture (intravenous cannulation) in children. A secondary aim was to examine the influence of age on the pain report and behavior and on the therapeutic outcome.. Children aged 4 to 16 years (N = 180) who were to undergo surgery under general anesthesia via intravenous cannulation were randomly allocated to one of three interventions. The comparison of lidocaine-prilocaine emulsion (EMLA, Astra) and a placebo emulsion was double-blind. Stratification by age group (4 to 6, 7 to 11, 12 to 16) ensured an equal number of children (20) in each intervention/age group category. A global assessment of the behavioral reaction to the procedure was made by the principal investigator, taking into account vocal, verbal, facial, and motor responses. The child was asked to assess pain severity on the Faces Pain Scale (FPS) and a visual analogue toy (VAT). The scales were applied conservatively as ordinal scales: FPS 0 to 6; VAT 0 to 10.. Children who received lidocaine-prilocaine emulsion reported less pain (mean FPS score = 1.42) compared with placebo emulsion (mean FPS score = 2.58) and with music distraction (mean FPS = 2.62). There was a highly significant therapeutic effect (P < .001) on the self-report and behavioral scores. Younger children, regardless of intervention, reported significantly more pain than the older children (mean FPS scores: 2.85, 2.33, 1.43 for age groups 4 to 6, 7 to 11, and 12 to 16 respectively; P < .001). The superiority of the local anesthetic emulsion was maximal in the youngest age group (4 to 6) almost eliminating pain-related behavior, and multiple regression analysis confirmed significant age and treatment effects and revealed interaction between therapeutic effect and age. Although a trend favoring the active emulsion was evident in the older children (7 to 11, 12 to 16) the differences were not significant. The pain scores were influenced by the type (gauge) of cannula, but this did not affect the conclusion regarding therapeutic and age effects. There was no influence of sex, experience with venipuncture, or whether the child was anxious on arrival in the operating room.. The results show that lidocaine-prilocaine emulsion is highly effective in preventing pain from venipunctures in young children, the group in most need of prevention.

Topics: Adolescent; Age Factors; Anesthetics, Local; Catheterization, Peripheral; Child; Child, Preschool; Double-Blind Method; Drug Combinations; Emulsions; Female; Humans; Injections; Lidocaine; Lidocaine, Prilocaine Drug Combination; Logistic Models; Male; Music; Pain; Pain Measurement; Prilocaine

Eutectic lidocaine/prilocaine cream 5% is a eutectic mixture of the local anaesthetics lidocaine (lignocaine) 25 mg/g and prilocaine 25 mg/g that provides dermal anaesthesia/analgesia following topical application. The principal indication in which eutectic lidocaine/prilocaine cream has been studied is the management of pain associated with venipuncture or intravenous cannulation, where significantly greater pain relief than placebo, with equivalent efficacy to ethyl chloride spray and lidocaine infiltration, has been demonstrated. In dermatological surgery, eutectic lidocaine/prilocaine cream offers effective pain relief in children undergoing curettage of molluscum contagiosum lesions, and in adults undergoing split-skin graft harvesting. Particular benefit has also been shown with use of eutectic lidocaine/prilocaine cream in association with treatment of condylomata acuminata in both men and women, and it appears to provide a useful alternative to lidocaine infiltration in this context. Further research in such indications as paediatric lumbar puncture, minor otological surgery, and minor gynaecological, urological and andrological procedures is likely to further broaden the profile of clinical use for eutectic lidocaine/prilocaine cream. Eutectic lidocaine/prilocaine cream has a very favourable tolerability profile, transient and mild skin blanching and erythema being the most frequent adverse events to occur in association with its application to skin. The potential for inducing methaemoglobinaemia, attributed to a metabolite of the prilocaine component of the formulation, prohibits its use in infants younger than 6 months. In summary, eutectic lidocaine/prilocaine cream is a novel formulation of local anaesthetics that has proven to be effective and well-tolerated in the relief of pain associated with various minor interventions in adults and children.

Topics: Anesthetics, Local; Animals; Drug Combinations; Drug Evaluation; Drug Tolerance; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Ointments; Pain; Prilocaine

Topics: Administration, Cutaneous; Adolescent; Anesthesia, Local; Anesthetics, Local; Bloodletting; Child; Child, Preschool; Clinical Trials as Topic; Drug Combinations; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Prilocaine

Topics: Anesthetics, Local; Child; Child, Preschool; Clinical Trials as Topic; Drug Combinations; Humans; Infant; Infant, Newborn; Injections; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Prilocaine; Punctures

Topics: Absorption; Anesthesia, Local; Child; Condylomata Acuminata; Drug Combinations; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Prilocaine

Laser hair removal is associated with moderate acute pain.. To compare effectiveness of ice pack to topical lidocaine-prilocaine for pain reduction during axillary laser hair removal.. Participants were randomly assigned to receive topical anesthetic to one axilla and ice packs to the other before each of 3, monthly 810 nm diode laser sessions. The primary endpoint was participant-reported pain on the visual analog scale (VAS) immediately following and 5 minutes after laser session. Posttreatment erythema, overall edema, and perifollicular edema were assessed by 2 blinded photoraters. Skin temperatures, patient preferences, and adverse events were recorded.. Eighty-eight of 90 (98%) planned laser treatments were delivered and randomized. Participants reported higher VAS scores immediately after laser treatment with lidocaine-prilocaine compared to ice (P = .03). Five minutes after, participants reported higher VAS scores with ice (P = .03). After 53 of the 88 treatments (60.2%), participants reported preferring ice (P = .055). No serious adverse events were reported.. All participants were Caucasian or Asian with Fitzpatrick skin type I to III and coarse dark axillary hair, which may limit generalizability.. While pain control with ice and topical anesthesia is associated with time after treatment, the 2 modalities do not differ in terms of degree of pain reduction associated with axillary laser hair removal.

Topics: Anesthetics, Local; Axilla; Hair Removal; Humans; Ice; Lasers, Semiconductor; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Prilocaine

Coughing caused by tracheal extubation is common following general anaesthesia. Heavy aerosol production by coughing during recovery from general anaesthesia in patients with respiratory infections (especially COVID-19) may be one of the highest risk factors for infection in healthcare workers. The application of local anaesthetics to the endotracheal tube is an effective method to reduce coughing. The most commonly used anaesthetics are compound lidocaine/prilocaine cream and tetracaine spray. However, coughing still occurs when the two anaesthetics are used alone. We speculated that the application of compound lidocaine/prilocaine combined with tetracaine spray would better prevent coughing caused by tracheal extubation.. Patients scheduled for laparoscopic cholecystectomy or cholecystectomy combined with common bile duct exploration under general anaesthesia were randomly assigned to Group C (saline spray), Group L (2 g compound lidocaine/prilocaine cream contains 5 mg of lidocaine and 5 mg prilocaine)), Group T (tetracaine) and Group F (compound lidocaine/prilocaine cream combined with tetracaine). The incidence of coughing, the endotracheal tube tolerance assessment, the incidence of agitation, the active extubation rate, the incidence of postoperative pharyngeal pain and the incidence of postoperative cough were recorded and analysed. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and the plasma concentrations of epinephrine and norepinephrine were measured immediately before extubation and 1 min after extubation.. A total of 211 patients were randomly assigned to Group C (53 cases), Group L (52 cases), Group T (52 cases) and Group F (54 cases). The primary result is assessment of the incidence of cough. The patients emerged from general anaesthesia, 96% of Group C had cough, which was significantly reduced in Group L (61.5%, P < 0.001), Group T (75%, P < 0.05) and Group F (22.2%, P < 0.001). Group F had a significantly reduced incidence of cough compared to Group L and Group T (P < 0.05 or P < 0.01, respectively). The secondary results were assessed. The endotracheal tube tolerance score in Group C ((1, 3) 4, P < 0.001) was higher than Group L ((0, 1) 2), Group T ((0, 1.25) 3) and Group F ((0, 0) 1). Group F had a significantly lower score than Group L and Group T (P < 0.05, P < 0.01, respectively). The incidence of agitation and the active extubation rate were also higher in Group C (96.2% and 71.7%, respectively, P < 0.001) than Group L (48.1% and 15.4%, respectively), Group T (61.5% and 26.9%, respectively) and Group F (17.3% and 7.7%, respectively). Blood pressure, HR and plasma concentrations of epinephrine and norepinephrine were significantly higher in Group C than in all other groups at the time of extubation and 1 min after extubation (P < 0.001). Group F exhibited significantly reduced blood pressure, heart rate and plasma concentrations of epinephrine and norepinephrine compared to Group L and Group T (P < 0.05, P < 0.01 or P < 0.001, respectively). The incidence of postoperative pharyngeal pain and the incidence of postoperative cough were not significantly different among the groups.. Compound lidocaine/prilocaine cream combined with tetracaine may be a more effective approach for preventing coughing and stabilising circulation during extubation following general anaesthesia. This may play an important role in preventing medical staff from contracting respiratory infectious diseases.. Chinese Clinical Trial Registry: ChiCTR2200058429 (registration date: 09-04-2022) "retrospectively registered".

Topics: Airway Extubation; Anesthesia, General; Anesthetics, Local; Cough; COVID-19; Double-Blind Method; Epinephrine; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Norepinephrine; Pain; Pharyngitis; Prilocaine; Tetracaine

Postoperative sore throat (POST) is a distressing complaint in adults after endotracheal intubation. This study aimed to evaluate the effect of topical application of a eutectic mixture of local anesthetics (EMLA) cream over the endotracheal tube (ETT) cuff on the incidence and severity of POST, cough, and hoarseness of voice in adults after surgery.. In this randomized, placebo-controlled study, adult patients 18 to 65 years old, in American Society of Anesthesiologists (ASA) physical status I and II, and of either sex were scheduled to receive 5% EMLA cream (intervention arm) or lubricant gel (placebo-controlled arm) applied over the ETT cuff. POST was graded as none (0), mild (1), moderate (2), or severe (3). A score of ≥2 was considered as significant POST. The incidence of POST at the sixth postoperative hour was the primary outcome. Secondary outcomes included the incidence of POST at 0, second, and 24 hours, and the incidence of significant POST (score ≥2). The incidence and severity of postoperative cough and hoarseness of voice were recorded simultaneously.. Two hundred and four patients completed the study. The incidence of POST was significantly lower in the EMLA group versus placebo at the sixth postoperative hour (4.9% vs 40.1%; relative risk [RR], 0.12; 95% confidence interval [CI], 0.05-0.29; P < .001); and at 0 hour (74.5% vs 93.1%; RR, 0.8; 95% CI, 0.7-0.9; P < .001) and second hour (51.9% vs 84.3%; RR, 0.61; 95% CI, 0.5-0.75; P < .001) but comparable at 24 hours (1.9% vs 3.9%; RR, 0.5; 95% CI, 0.09-2.67; P = .4). The number needed to treat to prevent POST with EMLA cream application was 5 at 0 hour and 3 at the second and sixth hour. The proportion of patients with significant POST over 24 hours were less in the EMLA group (9.8% vs 43.1%; P < .001). The incidence of postoperative cough and hoarseness of voice was significantly less at the 0, second, and sixth hours in the EMLA group, but comparable at 24 hours. The incidence of severe cough (8.8% vs 31.4%; P < .001) and hoarseness of voice (2% vs 7.4%; P < .001) over 24 hours was less in the EMLA group.. The application of EMLA cream over ETT cuff reduces the incidence and severity of POST, cough, and hoarseness of voice in adults after general anesthesia in the early postoperative period compared to lubricant gel.

Topics: Adolescent; Adult; Aged; Anesthesia, Endotracheal; Anesthesia, General; Anesthetics, Local; Cough; Hoarseness; Humans; Intubation, Intratracheal; Lidocaine; Lidocaine, Prilocaine Drug Combination; Middle Aged; Pain; Pharyngitis; Postoperative Complications; Young Adult

Neonatal circumcision is one of the most frequently performed procedures in male infants; it is also particularly painful. In a previous trial, we showed that the combination of Eutectic Mixture of Local Anesthetics (EMLA) + Sucrose + Ring Block (RB) was significantly effective in reducing pain during circumcision.. In this study, we added music as an adjunct aiming to further reduce the pain scores.. This was a double-blinded randomized controlled trial comparing EMLA + Sucrose + RB (Control) to EMLA + Sucrose + RB + Music (Intervention). The trial setting was the normal nursery of a university teaching hospital. One hundred and three healthy newborn males were randomized to each of the intervention and control groups. Babies were videotaped (face and torso) during the procedure for assessment of pain by two blinded and independent reviewers. The primary outcome measure was the NIPS score; secondary outcomes included heart rate, oxygen saturation and crying time.. The NIPS score of the intervention group (EMLA + Sucrose + RB + Music [2.6 ± 1.6]) was significantly higher than that of the control group (EMLA + sucrose + RB [1.4 ± 0.9]) (p = 0.00). Inter-rater reliability was high (κ .89). The intervention group registered significantly higher mean heart rate (142 bpm) and increased mean crying time (5.44 s) compared to the control group (135 bpm and 1.63s, respectively) (p = 0.01) and (p = 0.00). No adverse events were noted. Delivery music medicine by playing it from an iPad in the procedure room did not reduce pain during circumcision.. There is overwhelming evidence in the literature describing the effectiveness of music on pain management especially in the NICU. However, our results did not align with the general trend; not only did music medicine fail to enhance analgesia but it might have had the opposite effect, further agitating the infants, as indicated by the significantly increased heart rate, crying time and NIPS scores of the participants in the intervention group. Limitations of our study include the fact that this is a single center study and the method of delivering music via iPads instead of noise-canceling headphone.. Our results showed that music, delivered in this manner, may have increased agitation. We affirm the fact that the combination of EMLA + Sucrose + RB is highly effective for managing pain during circumcision and further reduction of already low scores might not be possible.. Registry Name: ClinicalTrials.gov; Registration number: NCT04252313; link: https://clinicaltrials.gov/ct2/show/NCT04252313.

Topics: Analgesia; Anesthetics, Local; Circumcision, Male; Humans; Infant; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Music; Pain; Prilocaine; Reproducibility of Results; Sucrose

Eyelid surgery under local anesthesia is a common procedure in ophthalmology. The most painful part is usually injecting local anesthesia. Decreased sensation from the very sensitive eyelid skin before injection is one of the few methods to relieve this stressful condition. In this study, we compared the use of the aesthetic property of cooling (cryoanalgesic) with topical EMLA® cream preparation before local anesthetic injection on the eyelid.. Thirty patients aged 47-81 years (mean = 65.6, SD = 9.75) undergoing upper eyelid blepharoplasty or levator advancement surgery were enrolled. Each subject's upper eyelid was randomly allocated by a computer-generated randomization sequence to an EMLA® cream or cryoanalgesic group before injecting local anesthetic. Pain monitoring was performed subjectively and objectively using a visual analog scale (VAS). Results were analyzed using the paired t-test.. No statistical difference was found in VAS score between the EMLA® cream (mean = 5.9) and cryoanalgesic groups (mean = 5.67) (. Topical EMLA® cream and cryoanalgesic have no difference in pain score from anesthetic infiltration during eyelid surgery.

Topics: Analgesics; Anesthesia, Local; Anesthetics, Local; Eyelids; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Prilocaine

To prevent pain associated with 8% capsaicin application, pretreatment with local anesthetics, such as EMLA (eutectic mixture of lidocaine 2.5% and prilocaine 2.5%), is considered an option. However, there is contradicting evidence regarding the effects of local analgesia on capsaicin-induced desensitization. In session 1, 2 skin areas in each forearm of 24 healthy volunteers were randomized to 2-hour pretreatment with EMLA/placebo cream. After pretreatment, 8% capsaicin patches were applied for 3 hours in 1 placebo and 1 EMLA pretreated area, obtaining the following four areas: Capsaicin + EMLA, Capsaicin + Placebo, EMLA alone, and Placebo. Pain intensity scores were assessed during the 3-hour application of capsaicin. Warmth detection, heat pain sensitivity, and microvascular reactivity were measured after the removal of capsaicin. After 24 hours, in session 2, all tests were repeated followed by histamine application in each area to examine itch intensity and neurogenic flare. Overall, EMLA caused significant reductions in capsaicin-induced pain compared with placebo (P= .007) and enhanced the capsaicin-induced increase in superficial blood perfusion immediately after the 3-hour capsaicin application (P< .01). Regardless of pretreatment, capsaicin induced heat hyperalgesia immediately after the application (P< .001). Twenty-four hours post application, heat pain sensitivity was normalized. However, WDT increased significantly (P< .001). Capsaicin tended to reduce the itch intensity and significantly reduced the neurogenic flare (P< .05) induced by histamine compared with EMLA alone. The findings suggest that pretreatment with topical analgesic cream reduces application site pain without interfering with the 8% topical capsaicin-induced desensitization. PERSPECTIVE: Pretreatment with local anesthetic EMLA cream might be considered a good therapeutic option to reduce the pain associated with 8% capsaicin application currently used for treatment of neuropathic pain syndromes. This study also suggests the existence of a synergistic effect of capsaicin and EMLA on the process of neurogenic inflammation.

Topics: Administration, Topical; Adult; Anesthetics, Local; Capsaicin; Female; Humans; Lidocaine, Prilocaine Drug Combination; Male; Pain; Pain Measurement; Pruritus; Sensory System Agents; Young Adult

Peripheral intravenous catheter (PIVC) practice is a common invasive procedure used in the diagnosis and treatment of pregnant women admitted to the hospital. Difficulties experienced during PIVC application are among the most common problems encountered in a medical facility.. The study intended to evaluate the effects of the Valsalva maneuver, the application of eutectic mixture of local anesthetics (EMLA) cream, and use of a stress ball in controlling the pain and discomfort that developed due to PIVC administration for pregnant women.. The research team designed the study as a randomized, controlled, single-blind trial.. The research took place at the obstetrics clinic at the Practice and Research Hospital at Yozgat Bozok University in Yozgat, Turkey, between January 2019 and February 2020.. Participants were 120 pregnant women who visited the obstetrics clinic and were admitted to the maternity ward of the hospital during that time.. Participants were divided into four groups of 30 women each: (1) the Valsalva maneuver group, (2) the EMLA group, receiving an application of the cream, and (3) the stress-ball group, and (4) the control group.. Data were collected through the use of a pregnancy information form and a visual analog scale. In the assessment of the data, variance analysis was used with the Kruskal Wallis and Dunn test.. Only the pain scores of the Valsalva maneuver group were found to be significantly lower than those of the control group, whereas the pain scores of the EMLA and stress-ball groups were similar to those of the control group.. The current study can generate awareness in pregnant women in terms of choosing between pharmacological and nonpharmacological practices that nurses use during PIVC insertion. As the only randomized controlled blind study that has been performed on the topic, the current study offers nurses evidence of a way to reduce PIVC pain in pregnant women.

Topics: Anesthetics, Local; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Phlebotomy; Pregnancy; Pregnant Women; Prilocaine; Single-Blind Method; Valsalva Maneuver

Arterial puncture is often painful for patients. The aim of this study was to compare use of local anesthesia as a eutectic mixture of 2 local anesthetics, lidocaine and prilocaine, versus placebo.. We conducted a double-blind, randomized controlled trial. Subjects were eligible if arterial puncture was indicated. The primary outcome was an experienced pain > 2 on a numerical pain rating scale. As having had a previous experience of arterial puncture was expected to be predictive of the current response, we planned 3 comparisons between use of local anesthesia and placebo: in the whole sample, among subjects with a painful previous experience, and among subjects with a painless previous experience. Multiple testing was analyzed using the Bonferroni correction for the primary outcome. The secondary outcome was the numerical pain rating scale score itself. All analyses were performed on an intention-to-treat basis.. A total of 136 subjects were included in this study. The primary outcome occurred in 20.9% in the active arm versus 37.7% in the placebo arm in the whole sample (relative risk 0.55; 95% CI when adjusting for multiple testing ranged was 0.28-1.09,. We found that application of a eutectic mixture reduced the number of painful arterial punctures by 50% compared with placebo. However, this result was not statistically significant. (ClinicalTrials.gov registration NCT01964248.).

Topics: Anesthesia, Local; Double-Blind Method; Humans; Lidocaine, Prilocaine Drug Combination; Pain; Pain Measurement; Punctures

Periodontal therapy usually requires local anesthesia. If effective, a non-invasive, liposomal anesthetic gel could increase the levels of acceptance of patients in relation to periodontal therapy.. This study investigated the efficacy of liposomal anesthetic gel for pain control during periodontal therapy.. Forty volunteers with moderate to severe chronic periodontitis were recruited, of which at least three sextants required periodontal therapy. At least one of the selected teeth had one site with a probing depth of ≥4 mm. The volunteers received the following three gels: a placebo, lidocaine/prilocaine (Oraqix®), or a liposomal lidocaine/prilocaine, which were applied to different sextants. Pain frequency was registered during treatment and the volunteers received a digital counter to register any painful or uncomfortable experiences. At the end of each session, the volunteers indicated their pain intensity using rating scales (NRS-101 and VRS-4). The volunteers had their hemodynamic parameters measured by a non-invasive digital monitor.. Pain frequency/intensity did not show statistical difference between intervention groups. The tested gels did not interfere with the hemodynamic indices. Dental anxiety, suppuration and probing depth could influence pain during periodontal therapy.. Our results suggest limited indications for the use of non-invasive anesthesia when used for scaling and root planing. Intra-pocket anesthetic gel could be a good option for anxious patients, or those who have a fear of needles.

Topics: Adult; Aged; Anesthesia, Dental; Anesthetics, Local; Chronic Periodontitis; Dental Scaling; Double-Blind Method; Female; Gels; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Pain Measurement; Periodontal Pocket; Placebos; Prilocaine; Root Planing; Young Adult

To compare pain control during vulvar biopsy after either application of 5% lidocaine-prilocaine cream or injection of 1% lidocaine.. In a single-site randomized trial, patients who needed vulvar biopsy on a non-hair-bearing surface were recruited from a gynecologic oncology clinic to compare lidocaine-prilocaine cream (placed at least 10 minutes before biopsy) with lidocaine injection (at least 1 minute prior). A sample size of 53 participants in each arm (N=106) was planned. Pain was recorded using a 100 mm visual analog scale at three time points: baseline, after application of anesthesia, and after biopsy. The primary outcome was highest pain score recorded. Secondary outcomes were pain score at biopsy, patient experience, and tolerability and acceptability. Linear regression was used to compare the primary outcome between arms while controlling for baseline vulvar pain. A convenience analysis was performed in March 2019.. From October 2018 to March 2019, 38 patients completed informed consent and were randomized. Participants were women with median age of 60 years. Most characteristics between groups were similar. Nineteen were analyzed in the lidocaine-prilocaine group, and 18 were analyzed in the lidocaine injection group. The median highest pain score in the lidocaine-prilocaine group was 20.0 mm vs 56.5 mm in the lidocaine injection group. Controlling for baseline pain, the highest pain score in the lidocaine-prilocaine arm was 25.7 mm lower than in the lidocaine injection arm (95% CI [-45.1 to -6.3]; P<.01). Patients randomized to lidocaine-prilocaine had a significantly better experience than those receiving injected lidocaine (median experience score 2.0 mm vs 17.0 mm; P=.02).. Lidocaine-prilocaine cream before vulvar biopsy resulted in a lower maximum pain score and a significantly better patient rating of the biopsy experience when compared with lidocaine injection. Lidocaine-prilocaine cream, alone, is a reasonable option to use for vulvar biopsy.. ClinicalTrials.gov, NCT03654417.

Topics: Aged; Anesthetics, Local; Biopsy, Needle; Female; Humans; Injections; Lidocaine; Lidocaine, Prilocaine Drug Combination; Linear Models; Middle Aged; Nerve Block; Ointments; Pain; Pain Management; Pain Measurement; Patient Satisfaction; Perineum; Vulva

Vascular access intervention therapy (VAIVT) is necessary to maintain vascular access in patients undergoing hemodialysis. VAIVT-associated vasodilatation is painful. However, few reports have focused on effective pain relief at the time of VAIVT. The present study was performed to determine whether lidocaine-propitocain cream, a eutectic mixture of local anesthetics (EMLA), effectively reduces VAIVT-associated pain in patients undergoing hemodialysis. This placebo-controlled, double-blind, crossover study was conducted in a single center. Among 210 patients who underwent a total of 437 VAIVT procedures from August 2017 to June 2018, 30 patients were randomly allocated to either the EMLA-placebo arm or placebo-EMLA arm at the time of VAIVT. EMLA application significantly reduced the visual analog scale score compared with placebo (47.0 ± 21.1 vs. 68.6 ± 20.7 mm, respectively; P < 0.05). EMLA is a safe and effective treatment for relief of VAIVT-associated pain in patients undergoing hemodialysis.

Topics: Aged; Anesthetics, Local; Cross-Over Studies; Double-Blind Method; Female; Humans; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Renal Dialysis; Treatment Outcome; Vascular Access Devices

Neonates feel pain. There is a concern among practitioners that pain of injecting analgesics to neonates prior to circumcision could as well be the same as the pain of the procedure. This has made many reluctant to offer effective analgesia for circumcision. If eutectic mixture of local anesthetics (EMLA) provides analgesia comparable to dorsal penile nerve block (DPNB), it will obviate needle prick and encourage analgesia use in neonatal circumcision.. To determine how the analgesic efficacy of EMLA compares with that of DPNB in neonatal plastibell circumcision.. A prospective study of 110 male neonates for plastibell circumcision randomized into two groups: A and B, of 55 each, received EMLA or DPNB as analgesia prior to circumcision, respectively. The pulse rates and SpO2 were recorded with pulse oximeter pre-procedural and at four stages of the procedure (adhesiolysis, dorsal slit, tying, and excision) for each neonate. Also the modification of neonatal infant pain scale (NIPS) was recorded during the procedure.. There were differential changes in SpO2 (lower absolute mean values) and pulse rate (higher absolute mean values) for neonates who received EMLA when compared with DPNB before the procedure. These differences were significant with SpO2 at adhesiolysis (91.0% and 95.0%), dorsal slitting (90.9% and 94.7%), and excision stages (93.4% and 95.3), respectively (P < 0.05). They were also significant with the pulse rates at adhesiolysis (167.9 and 158.6), dorsal slitting (174.3 and 161.7), and tying stages (182.2 and 169.0), respectively (P values = 0.013, 0.015, and 0.044, respectively). This shows DPNB is better than EMLA. However, the difference was not significant at the tying stage with SpO2 and at excision stage with PR (P > 0.05).. EMLA produces analgesic effect. However, it does not provide effective analgesia for plastibell circumcision in neonates. DPNB provides a better analgesia than EMLA for neonatal plastibell circumcision.

Topics: Anesthesia, Local; Anesthetics, Local; Circumcision, Male; Humans; Infant; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Nerve Block; Pain; Pain Management; Pain Measurement; Penis; Prilocaine; Prospective Studies; Treatment Outcome

The current study aims to compare the analgesic effect of lidocaine-prilocaine (LP) cream with lidocaine infiltration during repair of perineal tears after vaginal delivery.. A single center open-labeled randomized clinical trial was carried out in a tertiary University Hospital between October 2016 and May 2017 (Clinical Trials.Gov: NCT02883179). We included parous women, who delivered at gestational age >37 weeks with first- or second-degree perineal tears. The participants were randomized in a 1:1 ratio to either lidocaine infiltration (Group I); or application of LP cream (Group II) for pain relief during perineal repair. The primary outcome was the difference in mean pain score during perineal repair. Secondary outcomes included the participants' satisfaction, the need for additional anesthesia, the duration of perineal repair, and the rate of adverse effects of both medications.. The study included 144 participants randomized to both groups. The mean pain score during perineal repair was significantly lower in the LP cream group (3.86 ± 1.59) than the lidocaine infiltration group (5.99 ± 1.47) [p = .001]. The duration of repair was significantly shorter in the LP group than the lidocaine infiltration group (6.37 ± 3.68 versus 8.17 ± 2.75 min, respectively, p = .001). The need for additional anesthesia was quite similar in both groups (p = .371). More women in the LP cream group were satisfied than the other group with statistical significant difference (76.4 versus 30.6%, p = .000). No difference between side effects in both groups (p = .171) Conclusions: Topical application of lidocaine-prilocaine cream is an effective analgesic during repair of perineal tears with no harmful side effects.

Topics: Administration, Topical; Adult; Anesthetics, Local; Delivery, Obstetric; Female; Humans; Lacerations; Lidocaine, Prilocaine Drug Combination; Pain; Pain Measurement; Perineum; Pregnancy; Suture Techniques; Young Adult

Extracorporeal shock wave lithotripsy-related pain is the largest limiting factor in this technique. Our study aimed to compare the effectiveness of different types of analgesics for pain management used during ESWL sessions. We conducted a prospective study of 300 patients with urinary lithiasis justifying ESWL treatment. The patients were randomized to three groups: group I, included 100 patients who received intramuscular injection of 2cc of physiological saline solution (placebo), group II included 100 patients who received intramuscular injection of ketoprofen 100mg while group III included 100 patients who received lidocaine and prilocaine topical cream. Visual Analog Scale (VAS) was used to assess pain 10 minutes after and at the end of the session. Mean VAS score 10 minutes after and at the end of ESWL session was 3.7 and 4.91 respectively. There was no significant difference among the three groups with respect to: epidemiological data (age, sex, BMI, patient's history) and the characteristics of the renal stone (side, size, location, presence or not of double-J ureteral catheter). Eleven patients in the Group I terminated treatment early, with a significant difference compared to the other groups (p=0.003). VAS score 10 minutes after and at the end of ESWL session was statistically higher in Group I compared to Groups II and III (p < 0.001). Moreover, ESWL session was significantly more effective in Groups (II and III) compared to Group I (p<0.001). Pain treatment is necessary during ESWL sessions. Two painkillers molecules were assessed, which showed good pain control as well as an increase in the effectiveness of lithotripsy.

Topics: Adult; Aged; Aged, 80 and over; Analgesics; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Female; Humans; Ketoprofen; Kidney Calculi; Lidocaine, Prilocaine Drug Combination; Lithotripsy; Male; Middle Aged; Pain; Pain Measurement; Prospective Studies; Young Adult

Cryotherapy using liquid nitrogen is an effective and commonly used treatment for palmoplantar warts. However, pain can be a limiting factor in the effective use of cryotherapy. In this study, we found that a single application of anesthetic cream following cryotherapy treatment of warts reduced posttreatment pain and led to improved tolerability of the procedure.

Topics: Adolescent; Anesthetics, Local; Child; Cryotherapy; Female; Humans; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Treatment Outcome; Warts; Young Adult

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.

Topics: Anesthetics, Local; Child; Child, Preschool; Female; Hot Temperature; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Pain Management; Phlebotomy; Prilocaine; Prospective Studies

The aim of this study was to compare the effectiveness of a eutectic mixture of local anesthetic (EMLA) cream and forced cold air anesthesia (FCAA) on pain control during ablative fractionated carbon dioxide (CO. Fifteen volunteers participated in this prospective, controlled, split-face clinical study. EMLA cream was applied 60 minutes before the laser procedure on half of the face, and FCAA was performed on each subunit of the other half of the face. The laser procedure was performed on each half of the face. Patients rated their pain during the procedure using a pain scale scored from 0-10. Both doctor and nurse rated patient discomfort during the procedure using a scale scored from 0-10. The pain scores associated with both EMLA and FCAA sides of the face were compared statistically.. Patient pain scores and discomfort scores detected by doctor and nurse were not statistically different between EMLA and FCAA. There was no statistically significant difference between males and females.. Instead of using EMLA, FCAA-which can be applied in a shorter time-may be a cost-effective, simple, and safe local anesthesia method used in the ablative fractionated CO

Topics: Ablation Techniques; Adolescent; Adult; Anesthesia, Local; Anesthetics, Local; Cryotherapy; Face; Female; Humans; Lasers, Gas; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Pain Management; Prilocaine; Prospective Studies; Skin Cream; Young Adult

EMLA cream was developed to reduce pain during pulsed-dye laser (PDL) treatment; however, no standard assessment for the therapeutic outcomes of PDL with EMLA creams thus far available. This comparative, prospective clinical trial evaluates laser efficacy and pain reduction during PDL treatment with EMLA cream for local topical anesthesia. Nineteen patients with untreated port-wine stain (PWS) were treated using PDL and examined in this study. Treatment specifications included Vbeam® PDL (Candela Corp.), 595-nm wavelength, 9 J/cm

Topics: Female; Humans; Lasers, Dye; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Pain Measurement; Port-Wine Stain; Prilocaine; Prospective Studies; Treatment Outcome

Needle insertion is a routine procedure performed on cancer patients with totally implantable venous access device. Although this procedure is painful for most of the patients, it is regularly performed without topical application of local anesthetics. In our study, we assess the degree of pain associated with different duration times of EMLA cream.. A total of 361 cancer patients with totally implantable venous access devices were randomly divided into three groups: group 1-placebo, group 2-30 min after application of EMLA, and group 3-60 min after application of EMLA. In this double-blinded prospective study, the efficacy of EMLA cream was compared with a placebo cream by comparing the degree of pain experienced by the patient who was evaluated during and after needle insertion on a numeric rating scale.. The mean ± standard deviation of pain experienced by the patients was significantly (p < 0.05) lower in group C (0.69 ± 0.98) than groups B (1.11 ± 1.14) and A (1.91 ± 1.40). No significant (p > 0.05) difference was found in mean scores from inexperienced and experienced procedures of needle insertions among three groups. Comparing male patients, the female patients in group 1 and group 2 had lower numeric rating scale (1.59 ± 0.94, 1.39 ± 1.35; p < 0.01).. The present results review that the application of EMLA cream for 30 min is suitable, acceptable, and convenient in cancer patients with totally implantable venous access device undergoing needle insertion.

Topics: Administration, Cutaneous; Anesthetics, Combined; Anesthetics, Local; Antineoplastic Agents; Catheterization; Catheterization, Central Venous; China; Double-Blind Method; Female; Humans; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Needles; Neoplasms; Pain; Pain Measurement; Time Factors; Treatment Outcome; Vascular Access Devices

This study aimed to compare the effects of three interventions on pain, blood pressure, and pulse rate during infiltration anesthesia in patients about to undergo gamma knife surgeries.. The three interventions employed in a university-affiliated Hospital in J City, South Korea were as follows: EMLA cream plus Vapocoolant spray (Vapocoolant, n=30), EMLA cream plus 10.0% Lidocaine spray (Lidocaine, n=30), and EMLA cream only (EMLA, n=30). The equivalent control-group pre test - post test study design was used. Pain was assessed subjectively using the numeric rating scale (NRS) and objectively using a Galvanic Skin Response (GSR) tester. NRS scores were assessed after infiltration anesthesia and the GSR was assessed during infiltration anesthesia. Blood pressure and pulse rate were assessed twice: before and after infiltration anesthesia. Data were collected between August 3, 2016 and March 24, 2017.. NRS scores after infiltration anesthesia and the GSR during infiltration anesthesia were significantly lower in the Vapocoolant group than in the Lidocaine and EMLA groups (F=13.56, p<.001 and F=14.43, p<.001, respectively). The increase in systolic blood pressure (F=4.77, p=.011) and in pulse rates (F=4.78, p=.011) before and after infiltration anesthesia were significantly smaller in the Vapocoolant group than in the Lidocaine and EMLA groups; however, no significant differences were observed in diastolic blood pressures (F=1.51, p=.227).. EMLA cream plus Vapocoolant spray was the most effective intervention to relieve pain and to lower increase in systolic blood pressure and pulse rate caused by infiltration anesthesia for stereotactic frame fixation. Thus, application of Vapocoolant spray in addition to EMLA cream is highly recommended as a nursing intervention for patients undergoing gamma knife surgeries.

Topics: Aged; Anesthetics, Local; Blood Pressure; Female; Heart Rate; Humans; Hypothermia, Induced; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Neoplasms; Pain; Pain Management; Prilocaine; Radiosurgery; Surgical Fixation Devices; Treatment Outcome

There is no consensus on the most effective pain management for neonatal circumcision. We sought to compare different modalities.. This is a double-blinded randomized controlled trial comparing 3 combination analgesics used during circumcision (EMLA + sucrose; EMLA + sucrose + dorsal penile nerve block [DPNB]; EMLA + sucrose + ring block [RB]) with the traditional topical analgesic cream EMLA alone. The trial was set in the normal nursery of a teaching hospital. The sample included 70 healthy male newborns, randomly assigned to intervention and control groups at a 2:1 ratio. Infants were videotaped (face and torso) during the procedure for assessment of pain by 2 blinded, independent reviewers. The primary outcome measure is the Neonatal Infant Pain Scale score. Secondary outcomes include heart rate, oxygen saturation, and crying time.. Neonatal Infant Pain Scale scores were significantly lower in the intervention groups (EMLA + sucrose, mean [SD]: 3.1 [1.33]; EMLA + sucrose + DPNB: 3 [1.33]; EMLA + sucrose + RB: 2.45 [1.27]) compared with the control (5.5 [0.53]). Between-group analyses showed RB + EMLA + sucrose to be significantly more effective than EMLA + sucrose; EMLA + sucrose + DPNB (. During neonatal circumcision in boys, the most effective analgesia is RB combined with oral sucrose and EMLA cream.

Topics: Analgesia; Anesthetics, Local; Circumcision, Male; Double-Blind Method; Drug Therapy, Combination; Follow-Up Studies; Humans; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Nerve Block; Pain; Pain Management; Pain Measurement; Penis; Prilocaine; Prospective Studies; Reference Values; Sucrose; Treatment Outcome; Video Recording

More than 50% of children report apian during venepuncture or intravenous cannulation and using local anaesthetics before needle procedures can lead to different success rates. This study examined how many needle procedures were successful at the first attempt when children received either a warm lidocaine and tetracaine patch or an eutectic mixture of lidocaine and prilocaine (EMLA) cream.. We conducted this multicentre randomised controlled trial at three tertiary-level children's hospitals in Italy in 2015. Children aged three to 10 years were enrolled in an emergency department, paediatric day hospital and paediatric ward and randomly allocated to receive a warm lidocaine and tetracaine patch or EMLA cream. The primary outcome was the success rate at the first attempt.. The analysis included 172 children who received a warm lidocaine and tetracaine patch and 167 who received an EMLA cream. The needle procedure was successful at the first attempt in 158 children (92.4%) who received the warm patch and in 142 children (85.0%) who received the cream (p = 0.03). The pain scores were similar in both groups.. This study showed that the first-time needle procedure success was 7.4% higher in children receiving a warm lidocaine and tetracaine patch than EMLA cream.

Topics: Anesthetics, Local; Catheterization, Peripheral; Child; Child, Preschool; Female; Hot Temperature; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Phlebotomy; Prilocaine; Tetracaine

Frame application for gamma knife radiosurgery (GKR) may be perceived as painful by patients. This study was designed to assess the efficacy of EMLA (2.5% lidocaine/2.5% prilocaine) in pain reduction.. This was a prospective, randomized, and controlled trial approved by our institutional review board. Fifty-four patients undergoing outpatient GKR were divided into EMLA and placebo groups. Prior to frame placement, EMLA/placebo was applied to the patient's forehead. A visual analog scale (VAS) was used to measure pain during 4 intervals: frontal injections, occipital injections, frontal screw insertion, and overall discomfort. This study was designed to observe a difference of 1.0 on the VAS at a power of 95%.. VAS for EMLA versus placebo for frontal injections (5.2 ± 2.7 vs. 5.7 ± 2.0, respectively; p < 0.45), back injections, (6.5 ± 2.2 vs. 5.9 ± 2.3, respectively; p < 0.30), frontal pins (4.6 ± 2.7 vs. 4.6 ± 2.2, respectively; p < 0.99), and overall discomfort (p < 0.29) were not significantly different. A comparison between back and frontal injections for EMLA (6.54 vs. 5.19, respectively; p < 0.16) and placebo (5.89 vs. 5.68, respectively; p < 0.69) showed no significant difference between group and location (p < 0.21).. Application of EMLA did not significantly reduce pain when used preoperatively for frame fixation. EMLA is no longer used as part of our routine for patients undergoing GKR.

Topics: Administration, Topical; Adult; Aged; Anesthetics, Local; Brain Diseases; Forehead; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Middle Aged; Pain; Prilocaine; Prospective Studies; Radiosurgery; Treatment Outcome

Social housing is recommended where possible for laboratory mice. In order to achieve this, mice must be individually identifiable. Although, various methods are available, permanent identification is often required, such as ear notching. This method is likely to be painful and to date there is limited literature on pain assessment and alleviation for this routine husbandry practice. Here we aimed to determine if the mouse grimace scale (MGS) could be used to assess pain in C57BL/6 mice following routine ear notching. Langford et al. found that very acute noxious stimuli (i.e. < 10 min in duration) did not produce a change in MGS score in comparison to baseline. Here, no significant difference was found between MGS scores at baseline and immediately post ear notching, potentially indicating that the pain associated with ear notching is either too acute to assess using the MGS tool or the practice is not painful. Studies in other species indicate that ear notching is painful, therefore, unless we can confidently conclude that the process of ear notching is not painful, we should err on the side of caution and assume it is painful due to the large number of mice ear-notched and potential welfare consequences. Alternative methods of assessing pain following this routine practice should be used in order to assess both the potential pain in mice, and the effectiveness of analgesics or local anaesthetics to relieve any associated pain.

Topics: Analgesics; Animal Identification Systems; Animals; Ear; Facial Expression; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Mice; Mice, Inbred C57BL; Pain; Pain Measurement; Pain, Postoperative; Prilocaine

This study aims to analyze the efficiency of EMLA cream and ethyl chloride spray application for pain alleviation before botulinum toxin injection.. Forty-five patients were divided into 3 treatment groups. Skin cooling with ethyl chloride spray (in group 1), topical anesthetic cream (EMLA) (in group 2), was used on the forehead area on one side previous to injection; the opposite side served as the control. In the third group (n = 15), cold was applied using ethyl chloride spray to one side, and to the other side topical anesthetic cream (EMLA) was applied. A visual analog scale was used for pain intensity.. In the first group, the average pain score was 3.20 ± 1.20 on the side where ethyl chloride spray was applied and 7.26 ± 1.94 on the control side (P < 0.05). It was 4.20 ± 1.37 on the side receiving EMLA and 7.66 ± 1.54 (P < 0.05) on the control side in the second group. In the third group, the average score was 6.80 ± 1.37 for the EMLA side and 2.93 ± 1.03 for the ethyl chloride sprayed side (P < 0.05).. Skin cooling with ethyl chloride spray significantly decreases the pain associated during forehead botulinum toxin injections.

Topics: Acetylcholine Release Inhibitors; Adult; Aerosols; Anesthetics, Local; Botulinum Toxins, Type A; Cosmetic Techniques; Cross-Over Studies; Ethyl Chloride; Female; Forehead; Humans; Injections, Subcutaneous; Lidocaine; Lidocaine, Prilocaine Drug Combination; Middle Aged; Pain; Pain Measurement; Prilocaine; Prospective Studies; Skin Cream; Treatment Outcome

Several studies have shown that psychological factors such as learning, expectation, and emotions can affect pharmacological treatment and shape both favorable and adverse effects of drugs. This study investigated whether nocebo information provided during administration of an analgesic cream could reverse topical analgesia to hyperalgesia. Furthermore, we tested whether nocebo effects were mediated by negative emotional activation. A total of 142 healthy volunteers (73 women) were randomized into 6 groups. A topical analgesic cream (Emla) was administered together with suggestions of analgesia in 1 group, whereas another group received Emla with suggestions of hyperalgesia. Two other groups received a placebo cream together with the same information as the groups receiving Emla. A fifth group received Emla with no specific information about the effect, and the sixth group received no treatment but the same pain induction as the other groups. Heat pain stimulation (48°C) was administered during a pretest and 2 posttests. Pain was continuously recorded during stimulation, and measures of subjective stress and blood pressure were obtained before the pretest, after the application of cream, and after the posttests. The results revealed that pain was significantly lower in the group receiving Emla with positive information and highest in the groups receiving suggestions of hyperalgesia, regardless of whether Emla or the placebo was administered. Mediation analyses showed that stress and blood pressure mediated hyperalgesia after nocebo suggestions. These results suggest that nocebo information can reverse topical analgesia and that emotional factors can explain a significant proportion of variance in nocebo hyperalgesia.

Topics: Administration, Topical; Adult; Analgesia; Anesthetics, Local; Emotions; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Nocebo Effect; Pain; Pain Measurement; Prilocaine; Treatment Outcome; Young Adult

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 known Aims: this study aimed to determine the effect of EMLA on IUD insertion pain.. 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 group Statistical 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 used.. 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.

Topics: Adult; Analgesia; Anesthetics, Combined; Double-Blind Method; Female; Humans; Intrauterine Devices; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Prilocaine; Prospective Studies; Treatment Outcome

Venipuncture is one of the most painful events for children in hospitals. Valsalva maneuver (VM) decreases the incidence and severity of pain on venipuncture pain in adults. This study was designed to evaluate VM as compared with Eutectic Mixture of Local Anesthetic (EMLA(®)) cream for venipuncture pain in children.. In this study, we evaluated the effect of VM on venipuncture pain in children. 60 patients scheduled for elective surgery were randomly divided into three groups. In Group V, children were punctured during VM. In Group E, EMLA(®) 5 % cream and in Group C (control group) vaseline was applied on the non-dominant hand 60 min before the venipuncture. Patients made a pain assessment using visual analog score (VAS). Mean arterial pressure (MAP), heart rate (HR), and SpO2 measurements were obtained during the venous cannulation.. Respectively, the VAS was 2.15 ± 1.95 for Group V and 1.00 ± 0.79 for Group E and 2.55 ± 2.74 for Group C. A significant reduction in the severity of pain was observed in Group E. The difference being statistically significant (p < 0.05), the VAS of Group V was higher than Group E but lower than Group C (p > 0.05).. On the basis of data from this study, the VM is a simple and a practical method to reduce venipuncture pain in children but not as effectively as EMLA(®).

Topics: Anesthetics, Local; Child; Drug Combinations; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Pain Measurement; Phlebotomy; Prilocaine; Valsalva Maneuver

To evaluate the effectiveness of topical eutectic mixture of local anaesthetics (EMLA®) cream in reducing the pain associated with vaccination injections.. This was a randomized, double-blind, placebo-controlled study that included children who presented for routine immunization. Eligible children were randomly assigned to receive either EMLA® or placebo cream. The Modified Behavioural Pain Scale (MBPS) was used to assess baseline and postvaccination pain scores, while a visual analogue scale (VAS) was used to assess pain at the time of the needle prick and at the end of the injection.. A total of 107 children were enrolled in the EMLA® group and 109 children in the placebo group. The difference between the pre- and postvaccination MBPS scores was significantly lower in the EMLA group than in the placebo group (2.56 ± 1.96 versus 3.95 ± 2.20, respectively). The VAS scores at the time of the needle prick and after the injection were significantly lower in the EMLA® group compared with the placebo group (1.60 ± 1.67 versus 3.24 ± 2.01; 3.29 ± 2.27 versus 4.86 ± 2.20; respectively).. Application of EMLA® cream can be effectively incorporated as a routine pain-relieving intervention within routine vaccination appointments.

Topics: Administration, Topical; Anesthetics, Combined; Anesthetics, Local; Child; Child, Preschool; Double-Blind Method; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Pain Management; Pain Measurement; Placebos; Prilocaine; Vaccination

The use of skin needling is believed to aid the transdermal delivery of drugs, even if it is mostly used for skin collagen induction. The aim of this paper was to use skin needling, combined with a local anesthetic EMLA (eutectic mixture of lidocaine and prilocaine), as a way to enhance transdermal drug penetration and optimize the analgesic effects of common local anesthesia.. We recruited 15 patients. For each patient of our study we defined a skin area of 3 cm2 from two forearms: on one side, we used skin needling first and immediately thereafter applied the EMLA in occlusion for 60 minutes; on the other one, we only applied EMLA in occlusion for 60 minutes. Then, pain was induced in each patient's forearm by introducing a 27 G needle into the skin 4 mm deep three times. Lastly, pain sensation measures were registered and a middle value was calculated.. When skin needling is used in conjunction with EMLA applied in occlusion for 60 minutes on skin forearms, the level of pain sensation registered was significantly reduced on a Visual Analogue Scale compared to the application of EMLA alone.. The use of skin needling can improve the transdermal delivery of an emulsion-like eutectic mixture of local anesthetics (EMLA) and can introduce the use of this method for delivering topical molecules in dermatology.

Topics: Administration, Cutaneous; Adolescent; Adult; Anesthetics, Combined; Anesthetics, Local; Drug Delivery Systems; Equipment Design; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Needles; Pain; Prilocaine; Visual Analog Scale; Young Adult

The efficacy of lidocaine-prilocaine cream (EMLA(®)) analgesia in the practice of hysterosalpingography is controversial. This study provides new drill results and a new method of application in terms of mode, time and place. The aim of the paper is to investigate the efficacy of 5% lidocaine 25 mg-prilocaine 25 mg/g cream applied to the uterine cervix for reducing pain during hysterosalpingography.. A randomized, double blinded, controlled study set in the general gynaecology clinic of a university teaching hospital between September 2012 and June 2013. One hundred successive patients programmed to undergo hysterosalpingography were randomized to either 3 ml of EMLA (50) cream or 3 ml of placebo (50), placed endocervically and exocervically, 10 min before hysterosalpingography. Patients' intensity of pain was assessed in four steps: at baseline (speculum application), after application of Pozzi tenaculum and cannula on the uterine cervix, during cervical traction and after contrast medium injection, using a 10-cm Visual Analogue Scale (VAS) immediately after the procedure. The most painful step was also identified. VAS was administered again at one-month follow-up visit.. NCT01303614.. The contrast medium injection was the most painful step of hysterosalpingography in both groups (EMLA 3.96, placebo 4.54, 95%CI: -0.481 to 1.641). No differences were found between the two groups (P=0.281) during this step. When comparing the VAS scale after the application of Pozzi tenaculum and cannula (EMLA 1.06, placebo 3.34, 95%CI: 1.495-3.065) and after cervical traction (EMLA 2.54, placebo 3.46, 95%CI: 0.034-1.806), significantly less pain was experienced by the EMLA group than the placebo group: P=0.000 and P=0.042, respectively.. Endocervical and exocervical topical application of EMLA 10 min before performing hysterosalpingography significantly reduced pain during cervical manipulation with tenaculum and cannula and during cervical traction, but did not reduce pain during injection of contrast that was the most painful step.

Topics: Adult; Analgesia; Anesthesia, Local; Anesthetics, Local; Contrast Media; Double-Blind Method; Drug Combinations; Female; Humans; Hysterosalpingography; Injections; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Pain Measurement; Prilocaine

The aim of this paper was to optimize pain control during transrectal ultrasound (TRUS) guided prostate biopsy, the efficacy and safety of three different analgesic techniques were compared.. Two hundred and forty patients were prospectively randomized into 3 groups before TRUS guided prostate biopsy. Group A received combined periprostatic nerve block (PPNB) and perianal-intrarectal lidocaine-prilocaine (PILP) cream; group B: PILP cream; group C: PPNB. Pain was evaluated using 10-point Visual Analog Scale (VAS).. VAS during TRUS was lower in groups A and B vs. C (mean 1.3,1.4 vs. 5.1, P<0.001); VAS for PPNB was lower in group A and group B vs. C (mean 1.1,1.3 vs. 3.5, P<0.001). VAS for sampling wase lower in group A as compared to B and C (mean 0.6, 3.5 and 1.4, P<0.001). VAS on stratified analysis was significantly lower in groupA vs. B and C in patients <60 years, prostate >50 cc and those with lower anorectal compliance (P<0.001). The overall complication rate was similar in all three groups.. The combination of PILP and PPNB provides better analgesia, especially in patients <60 years, prostate volume >50 cc and lower anorectal compliance as compared to two modalities used alone during the sampling part of TRUS guided prostate biopsy with no increase in the complication rate.

Topics: Administration, Rectal; Aged; Analgesia; Anesthetics, Combined; Anesthetics, Local; Biopsy, Needle; Drug Therapy, Combination; Hemorrhage; Humans; Injections; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Nerve Block; Ointments; Pain; Pain Management; Pain Measurement; Prilocaine; Prospective Studies; Prostate; Ultrasonography, Interventional; Urinary Tract Infections

We investigated the efficacy of 5% lidocaine 25 mg-prilocaine 25 mg/g cream (EMLA(®) ) applied to the uterine cervix for reducing pain during diagnostic or operative hysteroscopy, using a visual analogue scale (VAS) for pain in a prospective randomized, non-blinded, controlled study in 92 successive patients. Patients were randomized to either 3 mL of EMLA cream or 3 mL of ultrasound gel (placebo), placed endocervically and exocervically, 10 min before hysteroscopy. Intensity of pain was evaluated immediately after the procedure using a 10-cm VAS. No differences were found between the two groups (p = 0.07). The number of women who wished to stop the procedure was significantly lower in the EMLA group compared with the control group (p = 0.013). We concluded that topical instillation of EMLA does not decrease pain during hysteroscopy, but does reduce a desire to abandon the procedure.

Topics: Anesthetics, Local; Cervix Uteri; Female; Humans; Hysteroscopy; Lidocaine; Lidocaine, Prilocaine Drug Combination; Ointments; Pain; Pain Measurement; Prilocaine; Prospective Studies

Topical capsaicin 8% was developed for the treatment of peripheral neuropathic pain. The pain reduction is associated with a reversible reduction of epidermal nerve fiber density (ENFD). During its application, topical capsaicin 8% provokes distinct pain. In a randomized, double-blind study analyzed with a block factorial analysis of variance, we tested whether cooling the skin would result in reliable prevention of the application pain without inhibiting reduction of ENFD. A capsaicin 8% patch was cut into 4 quarters and 2 each were applied for 1 hour on the anterior thighs of 12 healthy volunteers. A randomization scheme provided for 1 of the application sites of each thigh to be pretreated with EMLA and the other with placebo, whereas both application sites of 1 thigh, also randomly selected, were cooled by cool packs, resulting in a site temperature of 20°C during the entire treatment period. The maximum pain level given for the cooled sites (visual analogue scale [VAS] 1.3 ± 1.4) proved to be significantly lower than for the non-cooled sites (VAS 7.5 ± 1.9) (P < .0001). In contrast, there was no significant difference in application pain between the sites pretreated with EMLA or with placebo (VAS 4.1 ± 3.6 vs 4.8 ± 3.5, P = .1084). At all application sites, ENFD was significantly reduced by 8.0 ± 2.8 (ENF/mm ± SD, P < .0001), that is, 70%, with no significant differences between the sites with the different experimental conditions. In conclusion, cooling the skin to 20°C reliably prevents the pain from capsaicin 8% patch application, whereas EMLA does not. ENFD reduction is not inhibited by cooling.

Topics: Adult; Capsaicin; Cryotherapy; Double-Blind Method; Female; Follow-Up Studies; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Pain Management; Pain Measurement; Prilocaine; Transdermal Patch; Young Adult

To compare the clinical efficacy between locally applied diclofenac diethylamine gel, EMLA cream and systemically given diclofenac sodium for the pain relief during extracorporeal shock wave lithotripsy (SWL) using Dornier Delta Compact Lithotripter.. One hundred five patients with renal stones were randomly divided in to 3 groups. Group A was given intramuscular diclofenac sodium (1 mg/kg), 45 minutes before the procedure. In group B, 10 gm of eutectic mixture of local anesthetic (EMLA) cream and in group C, 15 gm of diclofenac diethylamine gel was applied locally 45 minutes before the procedure. Ten-score linear and visual analogue scale (VAS) was used to assess the severity of pain during the procedure. Analysis of variance (ANOVA) test was used to compare various parameters and analyzed statistically.. All the three groups were not statistically different with respect to age, weight, stone size, number of shock wave delivered and maximum voltage used (P > .05). The mean pain score in group A was 4.48, in group B was 3.60 and in group C was 3.95, which were not significantly different (P = 1.34). Complication like skin lesion was found only in injection diclofenac sodium group whereas cold sensation at the local site was typically found in diclofenac diethylamine gel group.. Although not statistically significant, the mean pain score in locally applied analgesic agents (EMLA and diclofenac diethylamine gel) is lower as compared to intramuscularly given diclofenac sodium. Among these two locally acting drugs, diclofenac diethylamine gel is an equally effective alternative to EMLA.

Topics: Adult; Analgesia; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Diclofenac; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Lithotripsy; Male; Pain; Pain Management; Prilocaine; Prospective Studies

Painful procedures for premature infants in neonatal intensive care units remain inevitable. The goal of this study is to evaluate the effect of an eutectic mixture of local anesthetic (EMLA) cream for minimizing pain in premature infants during venipuncture in neonatal intensive care units.. This study enrolled 32 premature infants. A repeated-measures design was used. The scores of the 'Neonatal Pain, Agitation and Sedation Scale' (N-PASS) of each enrolled preterm infant were measured before, during and 10 min after venipuncture without and with EMLA cream use. Paired t-tests were used to compare the difference of N-PASS scores without and with EMLA cream use.. Paired t-tests revealed a significant decrease in N-PASS scores during venipuncture in infants with EMLA cream. There was no significant change of N-PASS scores before, during and 10 min after venipuncture with EMLA cream by analysis of repeated analysis of variance.. EMLA cream for minimizing pain during venipuncture could be recommended for premature infants.

Topics: Administration, Topical; Anesthetics, Local; Female; Humans; Infant, Newborn; Infant, Premature; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Pain Management; Pain Measurement; Phlebotomy; Prilocaine

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.

Topics: Administration, Topical; Adolescent; Adult; Anesthetics, Local; Capsaicin; Double-Blind Method; Drug Combinations; Drug Evaluation; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Ointments; Pain; Pain Measurement; Phlebotomy; Prilocaine; Prospective Studies; Young Adult

An effective topical agent to reduce pain during local anaesthesia of the palate is not yet available. The aim of the present study was to evaluate the efficiency of liposome-encapsulated ropivacaine in different concentrations for topical anaesthesia of the palatal mucosa. In this single-blinded, placebo-controlled, crossover study 40 (20 male) healthy volunteers were randomised to be given: liposome-encapsulated 2% ropivacaine, liposome-encapsulated 1% ropivacaine, a eutectic mixture of 2.5% lidocaine and 2.5% prilocaine (EMLA), and liposomal placebo gel, topically on to the palatal mucosa of the right canine region for 5 min each, at four different sessions. Pain associated with insertion of a 30G needle, and with injection of a local anaesthetic, was rated on a visual analogue scale (VAS). The effect of liposomal ropivacaine 1% and 2% did not differ from that of placebo (p=0.3 and p=0.1, respectively) in reducing pain during insertion of the needle. Lower VAS were obtained with EMLA. In this group VAS were lower in women than men (p=0.007). There was no difference in VAS among groups (p=0.3) as far as injection of the local anaesthetic was concerned. In conclusion, liposomal-encapsulated ropivacaine formulations did not reduce the pain of insertion of a needle into the palatal mucosa. None of the anaesthetic formulations tested, including the positive control (EMLA), were effective in reducing the pain of an injection of local anaesthetic compared with placebo.

Topics: Administration, Topical; Adult; Amides; Anesthesia, Dental; Anesthetics, Combined; Anesthetics, Local; Cross-Over Studies; Female; Humans; Injections; Lidocaine; Lidocaine, Prilocaine Drug Combination; Liposomes; Male; Mouth Mucosa; Needles; Pain; Pain Measurement; Palate; Placebos; Prilocaine; Ropivacaine; Sex Factors; Single-Blind Method; Young Adult

The objective of the study is to compare the pain level of three methods of intratympanic (IT) injections using prospective, randomized clinical study in a tertiary care center. 39 patients with Ménière's disease and 30 patients with sudden sensorineural hearing loss are included. Excluded were patients treated for a chronic pain or those who took any pain killer for the last 24 h. Each patient received one IT injection a week, for three consecutive weeks. Three methods of IT injections were compared, with the application of EMLA cream on the tympanic membrane filling the external auditory canal 60 min before the procedure, with subcutaneous injection of lidocaine 1% with 1:100,000 epinephrine in the external auditory canal, and finally with an IT injection without any previous anesthesia. The pain intensity was immediately measured at 5 min, and then 45 min after the procedure, each time using four pain rating scales (visual analogue scale, numerical rating scale, verbal rating scale and categorical rating scale). No difference in pain intensity between the three methods of IT injections was detected by the visual analogue scale and numerical rating scale (p > 0.05). 45.8% of patients preferred the IT injection without previous anesthesia. However, methylprednisolone has been associated with pain intensity greater than that of gentamicin 45 min after the injection (p < 0.05). The IT injection performed without any previous anesthesia is an interesting option since it has not been shown to be more painful than the other methods of injections, and spares the patient from disadvantages associated with the anesthesia.

Topics: Adolescent; Adult; Aged; Anesthetics, Local; Anti-Bacterial Agents; Anti-Inflammatory Agents; Female; Gentamicins; Hearing Loss, Sudden; Humans; Injections; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Meniere Disease; Methylprednisolone; Middle Aged; Pain; Pain Measurement; Prilocaine; Prospective Studies; Tympanic Membrane

The aim the study was to determine the effect of SonoPrep® on the delivery and analgesic effects of EMLA® cream prior to intravenous (iv) cannulation in a tertiary pediatric emergency department. Children aged between 5 and 10 years were enrolled. Patients were randomized to receive either sonophoresis with SonoPrep® or sham sonophoresis followed by application of EMLA® cream for 5 min prior to iv cannulation. The primary outcome measurement was the child's rating of pain immediately after iv placement, using a 10-cm visual analog scale (VAS). Parents or guardians and blinded researchers were additionally asked to rate their perception of the child's pain using the 10-cm VAS and the Wong-Baker Face scale. A total of 42 patients completed the study (21 in the study group, 21 in the control group). The baseline characteristics between the groups were similar. The VAS pain score was significantly lower in children treated with sonophoresis compared with the sham sonophoresis (median (percentiles 25th-75th), 20.0 (10.0-22.5) vs. 60.0 (31.0-87.5); p < 0.001). The parent's perception of the child's pain was significantly lower in the study group vs. the control group by the VAS (median (percentiles 25th-75th), 10.0 (10.0-20.0) vs. 50.0 (15.0-80.0); p < 0.001) and Wong-Baker Face scale (median (percentiles 25th-75th), 2.0 (2.0-2.0) vs. 4.0 (2.5-4.5); p < 0.001). The researcher's evaluation of the child's discomfort was also significantly lower in the study group (2.0 (1.0-3.0) vs. 4.0 (2.5-4.5); p < 0.001). The application of sonophoresis using SonoPrep® followed by the 5-min application of EMLA® cream showed significant benefit in young children in terms of pain reduction and patient satisfaction.

Topics: Anesthetics, Local; Catheterization, Peripheral; Child; Child, Preschool; Double-Blind Method; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Pain Measurement; Patient Satisfaction; Phonophoresis; Prilocaine; Prospective Studies; Treatment Outcome

Patient collaboration in external shock wave lithotripsy (ESWL) is critical for its correct application, making proper analgesic selection indispensable. The aim of this study was to evaluate the efficacy of combined application of EMLA and intravenous (i.v.) pethidine compared with pethidine plus placebo cream in patients undergoing ESWL for ureteral and/or renal lithiasis. Prospective, controlled, randomized, double-blind study was conducted in patients receiving ESWL for renal and/or ureterolithiasis. The patients were randomly assigned to receive i.v. pethidine plus either EMLA cream (group A) or placebo hydrating cream (group B). Evaluated were type, location, and size of lithiasis, patient's sex, age, body mass index, comorbidity, Visual Analogue Scale (VAS) score of pain, and degree of lithiasis fragmentation. EMLA cream provided significantly better pain relief and lithiasis fragmentation and more completed ESWL treatment. Topical application of EMLA cream combined with i.v. pethidine improved VAS scores and lithiasis fragmentation and decreased the rate of withdrawal from ESWL procedure versus i.v. pethidine plus placebo therapy.

Topics: Adult; Aged; Anesthetics, Combined; Body Mass Index; Double-Blind Method; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Lithotripsy; Male; Meperidine; Middle Aged; Pain; Pain Measurement; Prilocaine; Prospective Studies

Pain, stress as well as drugs may affect metabolic and endocrine measurements, especially in stressed children. The aim was to study how release of glucose and stress hormones are affected when procedural sedation with nitrous oxide or midazolam are used for establishing intravenous access in obese and lean children.. In a prospective, double-blind, randomized study 90 children, 60 obese and 30 growth-retarded (GR), aged 5-18 years, with reported anxiety or difficulties connected with i.v. access, were randomized to 1 of 3 groups: oral midazolam (0.3 mg/kg, max. 15 mg), 50% nitrous oxide (N(2)O), and 10% N(2)O. In addition, all children received anesthesia cream (EMLA®) locally 1 h before i.v. access. Blood samples were drawn at 4 time points during 30 min after establishing venous access and, when feasible, after 24 h. The 24-hour sample was regarded as obtained during unstressed condition. The effect of procedural sedation was analyzed. Children's evaluations of pain (Numeric Rating Scale) and procedure (Likert Scale) were correlated with mean values of cortisol and glucose after i.v. access. For the metabolic and hormone control measurements, 60 children aged 4-18 years (40 obese and 20 GR) served as controls. These children underwent a 24-hour blood sampling and did not receive sedation. The control samples were drawn 10-12 h after i.v. access.. After midazolam, significantly lower cortisol levels were found compared to both 50% N(2)O and 10% N(2)O and to unstressed controls. The growth hormone levels decreased with time in the midazolam group compared to 50 and 10% N(2)O, where the effect of time was reversed. Glucose levels among GR children increased from 0 to 30 min, whereas the opposite was found in obese children regardless of treatment. A post hoc analysis demonstrated significant correlations between children's evaluations of the procedure and mean values of cortisol (r = -0.53), growth hormone (r = -0.52), and norepinephrine (r = -0.5) in children treated with a very low dose of N(2)O (10%).. When sedation is insufficient during i.v. access, and blood sampling pain and stress affect hormone values, treatment with N(2)O or midazolam influence the glucose and stress hormone levels differently. These differences need to be accounted for when results are used for diagnosis and clinical decisions.

Topics: Adolescent; Anesthetics, Local; Blood Glucose; Blood Specimen Collection; Catheterization, Peripheral; Child; Child, Preschool; Conscious Sedation; Growth Disorders; Human Growth Hormone; Humans; Hydrocortisone; Hypnotics and Sedatives; Insulin; Lidocaine; Lidocaine, Prilocaine Drug Combination; Midazolam; Nitrous Oxide; Norepinephrine; Obesity; Pain; Pain Measurement; Prilocaine; Prospective Studies; Stress, Psychological

The aims of this study are to evaluate the efficacy of a eutectic mixture of local anesthetic (EMLA) cream on pain perception during scaling and to compare the intensities of pain provoked by hand and ultrasonic instruments.. Forty subjects with chronic gingivitis or periodontitis were enrolled in the study. In this randomized, split-mouth, controlled, masked clinical trial, each of the four quadrants in subjects was randomly assigned to receive one of the following protocols: scaling with an ultrasonic scaler with or without the application of the EMLA cream or scaling with a Gracey curet with or without the application of the EMLA cream. Pain levels after each quadrant of scaling were assessed with a visual analog scale (VAS; 0 to 100 mm) and verbal rating score (VRS; 0 to 4). All subjects were recalled to detect any complications after 24 hours.. The mean VAS and VRS when EMLA cream was applied (18.39 ± 14.47 mm and 0.95 ± 0.69) were significantly lower (P <0.001 for VAS and VRS) compared to when EMLA cream was not used (26.54 ± 16.46 mm and 1.30 ± 0.75). The mean VAS and VRS of the ultrasonic scaler group (20.43 ± 16.40 mm and 0.98 ± 0.76) were significantly lower (P = 0.024 for VAS; P = 0.003 for VRS) than those of the Gracey curet group (24.50 ± 15.17 mm and 1.28 ± 0.69). None of the subjects showed adverse effects after EMLA-cream application.. Although most patients experienced limited pain during scaling, a significant reduction of pain is achieved by using EMLA cream and ultrasonic scaler.

Topics: Adult; Analysis of Variance; Anesthetics, Combined; Anesthetics, Local; Dental Instruments; Drug Combinations; Female; Follow-Up Studies; Gingivitis; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Matched-Pair Analysis; Middle Aged; Pain; Pain Perception; Periodontitis; Prilocaine; Root Planing; Single-Blind Method; Treatment Outcome; Ultrasonic Therapy; Young Adult

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.

Topics: Administration, Cutaneous; Adolescent; Adult; Aged; Anesthetics, Local; Dimethyl Sulfoxide; Drug Therapy, Combination; Female; Humans; Kidney Calculi; Lidocaine; Lidocaine, Prilocaine Drug Combination; Lithotripsy; Male; Middle Aged; Ointments; Pain; Pain Measurement; Prilocaine; Prospective Studies; Treatment Outcome; Ureteral Calculi; Young Adult

Transcranial direct current stimulation (tDCS) appears to have modulatory effects on the excitability of cortical brain tissue. Though tDCS as presently applied causes no apparent harm to brain structure or function, a number of uncomfortable sensations can occur beneath the electrodes during stimulation, including tingling, pain, itching, and burning sensations. Therefore, we investigated the effect of topically applied Eutectic mixture of local anesthetics (EMLA) on tDCS-related discomfort.. Nine healthy adults received both anodal and cathodal 2.0 mA tDCS for 5 minutes over the prefrontal cortex with the skin pretreated for 20 minutes with either EMLA or placebo cream. Participants rated procedural discomfort six times across eight dimensions of sensation.. On average, the mean sensation ratings for EMLA-associated tDCS stimulation were significantly lower than placebo-associated stimulation for every cutaneous sensation evaluated. Cathodal stimulation was associated with higher ratings of "sharpness" and intolerability than anodal stimulation.. Topical EMLA may reduce tDCS-related discomfort.

Topics: Adult; Electric Stimulation Therapy; Female; Forehead; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Prilocaine

Topics: Analgesia; Anesthetics, Local; Catheterization, Central Venous; Glucose; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Pain Measurement; Prilocaine

The goal of this study was to compare the analgesic effect of sucrose with that of the combination of sucrose and the local anesthetic cream EMLA during venipuncture in preterm neonates.. This randomized, double-blind prospective study included infants younger than 37 weeks' gestational age during 1 routine venipuncture for blood sampling. Each child randomly received either sucrose plus application of a placebo cream (S group) or sucrose plus EMLA cream (S+E group) before venipuncture. Venipuncture-induced pain was assessed through videotapes of the procedures by using the Douleur Aiguë Nouveau-né (DAN) behavioral scale. Pain was assessed at 2 phases: during venipuncture (from needle introduction to its removal) and during the recovery period (30 seconds after needle removal). Pain scores over time and between treatments were compared by using repeated-measures analysis of variance.. The study included 76 children (37 in the S group, 39 in the S+E group). Mean (SD) DAN pain scores for the S group and the S+E group were 7.7 (2.1) and 6.4 (2.5), respectively, during venipuncture and 7.1 (2.8) and 5.7 (3.3) during the postinjection period. A significant time and treatment effect in favor of the S+E group was observed.. The combination of sucrose and EMLA cream revealed a higher analgesic effect than sucrose alone during venipuncture in these preterm infants.

Topics: Administration, Oral; Analgesia; Anesthetics, Local; Dosage Forms; Double-Blind Method; Drug Therapy, Combination; Humans; Infant, Newborn; Infant, Premature; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Phlebotomy; Prilocaine; Prospective Studies; Sucrose

Thyroid fine needle aspiration biopsy (TFNAB) is the gold standard in the differential diagnosis of the thyroid nodules. In general, no analgesia is needed before this procedure. However, it is usually believed that the patients may be more comfortable if the procedure is performed under local anaesthetics. In this study, we examined the impact of the use of dermal anaesthetic on the patient's level of discomfort during palpation-guided TFNAB.. Fifty female patients with nodular goitre were enrolled in this study. Patients were randomised into two groups: a placebo cream was applied to group 1 patients (25 females; mean age 47.45 +/- 11.61 years), and local anaesthesia (EMLA 5% cream) was applied to group 2 patients (25 females; mean age 50.89 +/- 12.01 years) approximately 1 h before TFNAB. All patients were asked to mark the pain they felt during the TFNAB on Visual Analogue Scale.. The pain scores during TFNAB were 27.73 +/- 20.01 mm and 24.79 +/- 21.98 mm in the placebo group and in the EMLA group respectively. There was no significant difference between the groups (p = 0.496).. Topical anaesthesia before palpation-guided TFNAB provides no benefit.

Topics: Administration, Cutaneous; Adult; Analgesics; Anesthesia, Local; Anesthetics, Local; Biopsy, Fine-Needle; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Middle Aged; Pain; Pain Measurement; Palpation; Prilocaine; Thyroid Nodule

Venepuncture is one of the most stressful situations for children during induction of general anesthesia. Therefore, many clinicians use a local anesthesia patch (EMLA) containing a mixture of lidocaine and prilocaine in order to reduce the stress for pediatric patients. This study compared the effect of a new heated topical anesthesia delivery system containing lidocaine and tetracaine (Rapydan) with the lidocaine/prilocaine patch EMLA.. The study design was prospective, randomized, single-blinded and monocenter. A total of 200 children aged from 3 to 13 years were randomized into group E (EMLA) or group R (Rapydan). The primary endpoint of the study was the overall incidence of pain. Additionally, the intensity of pain during venous puncture was evaluated by means of an investigator-based 4 point pain score: 0 no reaction, 1 gentle movement/grimacing, 2 moderate withdrawal of the arm/crying and 3 strong withdrawal/screaming. Furthermore, erythema of the skin, visibility of the veins and success rate of the punctures were assessed.. Mean contact time of the patch with the skin was 35 min in both groups. The overall incidence of pain was 46% in group E and 12% in group R (p<0.001). The intensity of pain also differed significantly between the groups. A pain score of 1 was observed in 24% (group E) versus 10% (group R), a score of 2 was documented in 13% (group E) versus 1% (group R) and a score of 3 was observed in 9% (group E) versus 1% (group R; p<0.001). Erythema of the skin was observed more frequently in group R (p<0.001). Visibility of the veins and success rate of venous puncture did not differ significantly.. After a contact time of 35 min the Rapydan patch led to superior analgesia during venous puncture than the EMLA patch. With regard to visibility of the veins and success rate of the punctures, differences between the two patches were not observed.

Topics: Administration, Cutaneous; Adolescent; Anesthesia, Local; Anesthetics, Local; Behavior; Child; Child, Preschool; Double-Blind Method; Endpoint Determination; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Pain Measurement; Phlebotomy; Prilocaine; Prospective Studies; Tetracaine

The aim of this study was to compare the efficacy of topical piroxicam and EMLA cream on pain control and subsequent inflammation in neodymium:yttrium-aluminum-garnet (Nd:YAG) 1,064 nm laser hair removal in female volunteers. Fifty female volunteers were enrolled in this prospective, randomized, double-blind, clinical study over a 6-month period. Patients were randomly assigned to receive topical piroxicam as group Piroxicam or EMLA cream as group EMLA. Topical analgesics were applied to the treatment sites for 60 min. The pain scores [on a visual analog scale (VAS)] and side effects were recorded before the hair removal, during the hair removal, at the end of the hair removal, and 1 h, 2 h and 24 h after the hair removal. Patients' characteristics and the treatment settings of the Nd:YAG 1,064 nm laser were similar in the two groups. The pain scores (VAS) were similar, and satisfaction was high in both groups after the hair removal. The number of blanching and erythema episodes were significantly higher in group E than in group P (P < 0.001). Inflammatory side effects were less frequent in group P than in group E after the procedure (P < 0.001). This study showed that topical piroxicam and EMLA provided adequate and similar pain relief after Nd:YAG 1,064 nm laser hair removal in female volunteers. Topical piroxicam was associated with fewer inflammatory side effects than was EMLA cream, because of its anti-inflammatory effect after the procedure.

Topics: Administration, Topical; Adolescent; Adult; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Dermatitis; Double-Blind Method; Erythema; Female; Hair Removal; Humans; Lasers, Solid-State; Lidocaine; Lidocaine, Prilocaine Drug Combination; Low-Level Light Therapy; Pain; Piroxicam; Prilocaine; Prospective Studies; Young Adult

To our knowledge the optimal analgesia during prostate biopsy remains undetermined. We tested the efficacy and safety of combined perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block during transrectal ultrasound guided prostate biopsy.. A total of 280 patients were randomized to receive combined perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block (group 1), perianal-intrarectal lidocaine-prilocaine cream alone (group 2), periprostatic nerve block alone (group 3) or no anesthesia (group 4) before transrectal ultrasound guided prostate biopsy. Pain was evaluated with a 10-point visual analog scale at subsequent procedural steps, including perianal-intrarectal substance administration, prostate transrectal ultrasound, periprostatic nerve block and sampling. Complications were assessed by self-administered questionnaire and telephone interview.. The groups were comparable in patient age, prostate volume, pathology results and visual analog scale perianal-intrarectal substance administration. Visual analog scale results for transrectal ultrasound were lower in groups 1 and 2 vs 3 and 4 (mean 1.5 and 1.41 vs 5.37 and 5.31, p <0.001) and results for periprostatic nerve block were lower in group 1 vs 3 (mean 1.03 vs 3.74, p <0.001). Results for sampling were lower in groups 1 to 3 vs 4 (mean 0.77, 1.27 and 1.27 vs 4.33, p <0.001) and in group 1 vs 2 and 3 (p <0.001). Stratified analysis showed that visual analog scale sampling was lower in group 1 vs 2 and 3 in patients 65 years old or younger, those with a prostate greater than 49 cc and those with lower anorectal compliance (visual analog scale results for perianal-intrarectal substance administration greater than 2) (p = 0.006, <0.001 and 0.003, respectively). The overall complication rate was similar in all 4 groups (p = 0.87).. Our findings suggest that the combination of perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block provides better pain control than the 2 modalities alone during the sampling part of transrectal ultrasound guided prostate biopsy with no increase in the complication rate. The magnitude of this effect is higher in younger men, men with a larger prostate and men with lower anorectal compliance.

Topics: Administration, Topical; Aged; Analgesia; Analysis of Variance; Biopsy, Needle; Chi-Square Distribution; Combined Modality Therapy; Follow-Up Studies; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Linear Models; Male; Middle Aged; Multivariate Analysis; Nerve Block; Ointments; Pain; Pain Measurement; Patient Satisfaction; Perineum; Prilocaine; Probability; Prostatic Neoplasms; Rectum; Reference Values; Risk Assessment; Ultrasound, High-Intensity Focused, Transrectal

We compared the lidocaine/tetracaine patch [Synera (USA), Rapydan (Europe)], a novel heat-aided patch using a eutectic mixture of lidocaine 70 mg and tetracaine 70 mg, with a eutectic mixture of lidocaine 25 mg ml(-1) and prilocaine 25 mg ml(-1) (EMLA Cream). The agents were administered at different time periods for local topical anaesthesia before a vascular access procedure.. In this double-blind, paired study, 82 adult volunteers were randomized to receive the lidocaine/tetracaine patch on one anticubital surface and lidocaine/prilocaine cream on the other concurrently for 10, 20, 30, or 60 min before a vascular access procedure. Subjects rated pain intensity using a 100 mm visual analogue scale (VAS). Skin reactions and adverse events were also evaluated.. Median VAS scores were significantly lower for the lidocaine/tetracaine patch than for lidocaine/prilocaine cream in the 10 min (P=0.010), 20 min (P=0.042), and 30 min (P=0.001) application groups. The lidocaine/tetracaine patch was associated with significantly more erythema than lidocaine/prilocaine cream at 20, 30, and 60 min, whereas lidocaine/prilocaine cream produced more blanching than the lidocaine/tetracaine patch at 30 and 60 min. Two subjects reported nausea and faintness associated with the vascular access procedure; one was withdrawn from the study.. The lidocaine/tetracaine patch provided effective anaesthesia with an application time as short as 10 min and was better than lidocaine/prilocaine cream at all application times shorter than 60 min, demonstrating a substantial improvement in time to onset of anaesthesia. The lidocaine/tetracaine patch provided an important alternative to lidocaine/prilocaine cream for topical local anaesthesia.

Topics: Administration, Cutaneous; Adolescent; Adult; Anesthesia, Local; Anesthetics, Combined; Anesthetics, Local; Double-Blind Method; Drug Combinations; Drug Delivery Systems; Female; Hot Temperature; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Ointments; Pain; Pain Measurement; Phlebotomy; Prilocaine; Tetracaine; Young Adult

To determine the optimal place to apply the local anesthetic agent and to investigate the efficacy of lidocaine-prilocaine cream on the perianal and intrarectal region during prostate biopsy.. The study included 80 patients. Patients were randomized into four groups: group 1 served as the control group and was administered no anesthesia; group 2 received 5 ml lidocaine-prilocaine cream perianally; group 3 received 5 ml lidocaine-prilocaine cream intrarectally, and group 4 received lidocaine-prilocaine cream perianally and intrarectally. Pain scores during probe insertion, biopsy procedure, and the overall pain score were assessed. Mean pain scores in each group were compared statistically.. In group 1, the mean pain score was significantly higher during probe insertion than that during biopsy (p < 0.001). For the mean overall pain scores, there was no significant difference between groups 1 and 3 (p = 0.942), but the results of group 1 were statistically different from groups 2 (p = 0.001) and 4 (p < 0.001). When we compared the biopsy pain scores, there was no significant difference among the groups (p > 0.05). During probe insertion, subjects in groups 2 and 4 reported significantly lower pain scores than the control group (p = 0.002, p = 0.001, respectively).. Perianal anesthesia with lidocaine-prilocaine cream may solely be sufficient to decrease the pain during prostate biopsy.

Topics: Administration, Rectal; Aged; Anesthetics, Combined; Anesthetics, Local; Biopsy; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Ointments; Pain; Pain Measurement; Prilocaine; Prospective Studies; Prostate; Prostate-Specific Antigen; Prostatic Neoplasms; Treatment Outcome; Ultrasonography, Interventional

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).. 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.. 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).. 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.

Topics: Adult; Analgesia; Anesthetics, Combined; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Diclofenac; Female; Humans; Kidney Calculi; Lidocaine; Lidocaine, Prilocaine Drug Combination; Lithotripsy; Male; Middle Aged; Pain; Pain Measurement; Prilocaine; Prospective Studies; Treatment Outcome

Topical anaesthetics reduce the pain of venous cannulation. The emergency department at the Starship Children's Hospital in Auckland uses EMLA (an eutectic mixture of 25 mg/g lidocaine and 25 mg/g prilocaine) for topical anaesthesia. Amethocaine has recently been shown to be a more effective topical anaesthetic. It is suggested that, because amethocaine does not vasoconstrict veins, it may increase the success of cannulation.. The primary aim was to determine if amethocaine improves the success of cannulation compared with EMLA. The secondary aim was to determine if amethocaine is a more effective topical anaesthetic in a children's emergency department.. A parallel, randomised, double-blind controlled study was performed in children aged 3 months to 15 years who were offered topical anaesthesia for venous cannulation. Caregivers gave verbal consent at triage, followed by written consent. Children were randomised into amethocaine or EMLA groups. Those who went on to have an intravenous cannula were analysed on an intention-to-treat basis. The primary outcome was a successful first attempt at cannulation. A convenience cohort was also observed for distress using a visual analogue scale and the Faces, Legs, Activity, Cry and Consolability Score.. From November 2006 to June 2007, 2837 children were enrolled and 809 were known to have had intravenous cannulation. 679 complete data and consent forms were returned. There was no significant difference between the first attempt success rates (75.8% amethocaine vs 73.9% EMLA) or between pain scores for the 65 observed cannulations.. Amethocaine is not more successful than EMLA for first attempt intravenous cannulation in a children's emergency department.

Topics: Administration, Topical; Adolescent; Anesthetics, Combined; Anesthetics, Local; Catheterization; Child; Child, Preschool; Double-Blind Method; Emergency Service, Hospital; Female; Humans; Infant; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Prilocaine; Tetracaine; Treatment Outcome

The purpose of this study was to compare the effectiveness of topically applied lidocaine-prilocaine (EMLA) cream with local anesthetic infiltration in the reduction of pain during perineal suturing after childbirth.. Sixty-one women with either an episiotomy or a perineal laceration after vaginal delivery were assigned randomly to receive either the application of EMLA cream (n = 31) or infiltration with mepivacaine (n = 30) before perineal suturing. Primary outcome was pain during perineal repair.. Women in the EMLA group had lower pain scores than those in the mepivacaine group (1.7 +/- 2.4 vs 3.9 +/- 2.4; P = .0002). The proportion of women who needed additional anesthesia was similar in the 2 groups (3/30 vs 5/31; P = .71). A significantly higher proportion of women expressed satisfaction with anesthesia method in the EMLA group, compared with the mepivacaine group (83.8% vs 53.3%; P = .01). EMLA cream appears to be an effective and satisfactory alternative to local anesthetic infiltration for the relief of pain during perineal repair.

Topics: Administration, Topical; Adult; Anesthetics, Combined; Anesthetics, Local; Delivery, Obstetric; Episiotomy; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Mepivacaine; Pain; Parturition; Patient Satisfaction; Perineum; Pregnancy; Prilocaine; Sutures; Vaginal Creams, Foams, and Jellies

Pregnancy is associated with reduced local anesthetic requirements and increased pain thresholds, possibly due to hormonal changes and activation of endogenous opioids.. We compared the responses to a mechanical and an electrical stimulus in 30 pregnant women (pregnant group) scheduled for cesarean section and 30 healthy female volunteers (control group) matched for age. Pain was assessed by Visual Analogue Scale (VAS) on two different days after skin application of EMLA or placebo cream on the forearms. EMLA and placebo cream were randomly applied on the medial surface of both forearms for 30 min in a blind cross over manner and the subjects received a mechanical stimulus generated through a pressor palpator followed by an electrical stimulus generated through a nerve stimulator.. Average VAS values from both trials did not differ between pregnant and control group exposed to the mechanical or electrical stimulus after EMLA application or after mechanical or electrical stimulus after placebo cream application... Late pregnancy is not associated with increased sensitivity to local anesthetics (EMLA) applied to the skin, under our study conditions.

Topics: Adult; Anesthetics, Local; Case-Control Studies; Cross-Over Studies; Double-Blind Method; Electric Stimulation; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Pain Measurement; Pain Threshold; Pregnancy; Pregnancy Trimester, Third; Prilocaine; Prospective Studies

To examine the efficacy and safety of a new topical anesthetic containing a disinfection ingredient (LidoDin cream) in reducing the pain associated with venipuncture by comparing it with the proven eutectic mixture of lidocaine 2.5% and prilocaine 2.5% (EMLA cream).. A single-blind, randomized, controlled trial was conducted on a study population consisting of a convenience sample of patients aged 12 to 16 years who presented at our Emergency Department between November 2007 and April 2008. The Visual Analog Scale (VAS) was used for pain assessment. Before the study, the bactericidal effect of the LidoDin cream on skin flora was tested.. Twenty patients were enrolled to each arm of the study. Mean patient age was 13.6 years for the LidoDin group and 14.12 years for the EMLA group (P=0.347). Male patients accounted for 55% of the patients in the LidoDin group, compared with 40% in the EMLA group (P=0.527). Skin reaction scores of the LidoDin group for erythema and edema were not statistically different than those of the EMLA group (P=0.73 and P=0.75, respectively). Patient VAS scores and nurse VAS scores of the LidoDin group were not statistically different than those of the EMLA group (P=0.57 and P=0.93, respectively).. This pilot study demonstrated that LidoDin and EMLA seem to be equally safe and effective topical anesthetics for venipuncture. Future studies are planned to determine, if LidoDin reduces the rate of local skin infection in patients treated with multiple daily subcutaneous injections of medications.

Topics: Adolescent; Adult; Anesthetics, Combined; Anesthetics, Local; Child; Disinfectants; Edema; Erythema; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Pain Measurement; Phlebotomy; Prilocaine

To compare the effect of eutetic mixture of local anesthetics (EMLA) with Ametop in providing local anesthesia for grommet insertion.. Double-blind randomized clinical trial.. University teaching hospital.. Forty-one adult patients diagnosed with otitis media with effusion were recruited into the trial and underwent grommet insertion under local anesthesia; 21 were randomly allocated to the EMLA group and 20 to the Ametop group.. The primary outcome measure of the study was the level of pain experienced by the patient. The secondary outcome measure was the overall satisfaction with the procedure. Both measures were assessed using visual analogue scales.. Both the topical anesthetic agents provided good pain relief during grommet insertion. There was no statistically significant difference in the pain or satisfaction scores.. Both EMLA and Ametop can provide good local anesthetic effect during grommet insertion.

Topics: Anesthetics, Local; Double-Blind Method; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Middle Ear Ventilation; Pain; Patient Satisfaction; Prilocaine; Tetracaine

EMLA has a slow onset due to its limited percutaneous absorption into an intact skin, while Glycolic acid (GA) has been known to have the capability of disrupting the skin barrier function. To the best of our knowledge, the effect of 50% GA on the percutaneous absorption of EMLA has not been studied previously.. The study used a two-step randomized double blind controlled trial involving 20 healthy subjects each. The first step compared the pain intensity upon applying GA and placebo for 4 minutes prior to EMLA occlusive application over time. Based on findings made in the first step, second step observation focused on the effect of occlusion on EMLA percutaneous absorption after GA application in minute 30 and 45. A second of 20 mA electrofulguration induced the pain, while modified Verbal Rating Scale (VRS) measured the pain intensity.. Significant VRS difference (P < 0.05) between GA and placebo group was found in minute 15, 20, 30 and 45. However, no significant VRS difference was found after minute 60 (P = 0.420). Adequate cutaneous analgesia was achieved in minute 30 in the treatment (GA) group and in minute 45 in the placebo. There was no significant VRS difference between the occlusive and non-occlusive group in minute 30 (P = 0.214) and minute 45 (P = 0.309).. Administering 50% GA prior to EMLA application enhances percutaneous absorption of EMLA, which accelerates the onset of adequate cutaneous analgesia, even without using an occlusive dressing.

Topics: Adolescent; Adult; Anesthetics, Local; Double-Blind Method; Drug Synergism; Drug Therapy, Combination; Electric Stimulation; Female; Glycolates; Humans; Keratolytic Agents; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Occlusive Dressings; Pain; Pain Measurement; Prilocaine; Skin; Skin Absorption; Statistics, Nonparametric; Time Factors

Palivizumab (Synagis [Abbot Laboratories, Kent, United Kingdom]) is recommended for the prevention of severe lower respiratory tract infections caused by respiratory syncytial virus in infants at high risk. These injections are very painful, and currently the use of analgesics is not systematic. The objective of this study was to compare the efficacy of EMLA with premixed 50% nitrous oxide/oxygen, used alone or combined with EMLA, for pain alleviation during palivizumab injections.. This randomized, double-blind, multicenter study included children who were younger than 24 months. Each child randomly received during the first 3 monthly injections 3 different analgesic interventions: (1) EMLA: application of EMLA plus air inhalation; (2) nitrous oxide/oxygen: inhalation of 50/50 nitrous oxide/oxygen plus application of a placebo cream; and (3) nitrous oxide/oxygen plus EMLA: inhalation of 50/50 nitrous oxide/oxygen plus application of EMLA. Each child was his or her own control. Procedural pain was assessed through videotapes with the Modified Behavioral Pain Scale. The procedure itself was subdivided in 2 periods: (1) injection and (2) recovery (first 30 seconds after the removal of the needle). Modified Behavioral Pain Scale scores over time (injection and recovery periods) and among treatments were compared by repeated-measures analysis of variance.. Fifty-five children were included. Mean +/- SD Modified Behavioral Pain Scale pain scores for EMLA, nitrous oxide/oxygen, and nitrous oxide/oxygen plus EMLA were, respectively, 9.3 +/- 1.0, 8.8 +/- 1.2, and 8.2 +/- 1.8 during the injection and 7.8 +/- 1.7, 7.4 +/- 1.9, and 6.9 +/- 2.4 during the recovery period. A significant time and treatment effect in favor of the combined nitrous oxide/oxygen plus EMLA was observed.. The administration of 50/50 nitrous oxide/oxygen to infants and young children is effective in decreasing the pain associated with palivizumab intramuscular injections. The combined nitrous oxide/oxygen plus EMLA cream was more effective than either EMLA cream or nitrous oxide/oxygen alone.

Topics: Analgesics, Non-Narcotic; Anesthetics, Local; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antiviral Agents; Child, Preschool; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Infant; Injections, Intramuscular; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Nitrous Oxide; Ointments; Pain; Palivizumab; Prilocaine

Post-occlusive and local thermal hyperemia are currently used as integrated tests to study microvascular function in microvascular diseases. However, further pathophysiological insight would require its association with microdialysis. The major limitation remains the microinvasive approach as local anaesthesia prior to fiber insertion could lead to confounding effects. The objective of our study was to determine whether EMLA cream treatment, applied for 20 min, 40 or 60 min, significantly decreases the pain related to intradermal needle insertions, while not decreasing the microvascular response to post-occlusive and thermal hyperemia 2 h after cream removal. EMLA cream, when applied during 40 min, induces a significant 75% decrease in the pain following intradermal needle insertion, while not modifying skin post-occlusive and thermal hyperemia 2 h after cream removal. Therefore, we recommend its use in such conditions before performing microdialysis coupled with laser Doppler flowmetry in cohort studies aimed at studying microvascular dysfunction in patients with microvascular diseases.

Topics: Administration, Topical; Adult; Anesthetics, Combined; Anesthetics, Local; Blood Flow Velocity; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Humans; Hyperemia; Injections, Intradermal; Laser-Doppler Flowmetry; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Microcirculation; Microdialysis; Needles; Ointments; Pain; Pain Measurement; Pain Threshold; Prilocaine; Skin; Time Factors

We sought to evaluate the effects and optimal application time of a eutectic mixture of local anesthetic cream (EMLA-C) in relieving wrist pain during transradial coronary procedures (TRCP).. The Phase I study enrolled 147 patients to evaluate the efficacy and safety of the EMLA-C during TRCP. The Phase II study was designed to evaluate the optimal preprocedure application time frame of EMLA-C for wrist pain reduction in 400 patients. The EMLA or placebo cream was applied at the puncture site from 2 to 4 hours before the procedure in Phase I, and randomized to 5 time groups according to the time of drug application in Phase II. We evaluated wrist pain by the visual analogue scale (VAS) or verbal rating scale (VRS-4), and evaluated complications as well.. EMLA-C demonstrated greater pain relief by VAS (control: 49+/-24, EMLA: 19+/-22; p = 0.001) and VRS-4 (control: 2.3+/-0.5, EMLA: 1.5+/-0.6; p = 0.001), and there was a negative correlation (r = -0.476; p = 0.001) between VAS and the preprocedure application time of EMLA-C. In Phase II, there was a significant difference in pain levels between the control and 1- to 2-hour groups by VAS (control: 49+/-29, EMLA1-2 hours: 32+/-24; p = 0.001) and VRS-4 (control: 2.4+/-0.6, EMLA1-2 hours: 1.9+/-0.6; p = 0.001). Drug-induced local erythema frequently occurred in the 3- to 4-hour group (6.6%) and >4 hours group (11.9%).. EMLA-C can be effective in reducing wrist pain during TRCP without any significant drug-related complications when the application time is 1 to 3 hours before the procedure.

Topics: Aged; Analysis of Variance; Anesthesia, Local; Cardiac Catheterization; Case-Control Studies; Catheterization, Peripheral; Coronary Angiography; Coronary Disease; Drug Combinations; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Ointments; Pain; Pain Measurement; Patient Satisfaction; Prilocaine; Probability; Radial Artery; Reference Values

The aim of this study was to compare the topical anesthetic effect of 20% benzocaine gel with 2.5% lidocaine/2.5% prilocaine (L/P) cream and gel on the pain experienced during palatal anesthetic infiltration.. Two groups were studied, each containing 20 subjects. Two types of L/P mixtures were tested, an anesthetic cream (EMLA) and a thermosetting gel (Oraqix), and benzocaine was used as control. The topical agents were applied on the palatal mucosa at the canine region. A needle prick was given on each side every 2 minutes during a period of 10 minutes. The subjects recorded their findings using verbal and VAS scales.. Pain scores were significantly less (P < .05) with EMLA and Oraqix than with benzocaine.. Topical application of EMLA and Oraqix before palatal anesthetic infiltration is associated with less pain than with benzocaine gel.

Topics: Adult; Anesthesia, Dental; Anesthesia, Local; Anesthetics, Local; Benzocaine; Gels; Humans; Injections; Lidocaine; Lidocaine, Prilocaine Drug Combination; Mouth Mucosa; Needles; Ointments; Pain; Pain Measurement; Palate, Hard; Prilocaine; Single-Blind Method

To compare the efficacy and side effects of transdermal diclofenac patch with eutectic mixture of local anesthetic (EMLA) cream in attenuating venous cannulation pain.. Adult ASA I or II patients undergoing elective surgery were randomly divided into three groups of 150 each. Group 1 (Control) patients received a placebo patch; Group 2 (EMLA) patients received EMLA cream; Group 3 (Diclofenac) patients received a transdermal diclofenac patch. The patches were applied at the proposed venous cannulation site 60 min prior to cannulation and pain resulting from an 18G cannula was assessed on an ten-point visual analogue scale (VAS). The cannulation site was observed for blanching, erythema, induration and edema for up to 24 hr.. The incidence of venous cannulation pain was 100% in the control group, as compared to 37% and 48% of patients who experienced pain in the EMLA (P = 0.001) and diclofenac (P = 0.001) groups, respectively. The severity of venous cannulation pain [median (VAS) with interquartile ranges] was also higher in the control group: 6 (3) as compared to VAS sores of 0 (1) and 0 (2) in the EMLA (P = 0.001) and diclofenac (P = 0.001) groups. Blanching occurred with greater frequency in the EMLA group compared with the diclofenac (P = 0.001 at six hours) and placebo groups (P = 0.001 at six hours). Erythema, induration and edema were reduced in the diclofenac group compared with the EMLA (P = 0.001 for all comparisons) and placebo groups (P = 0.04 for edema at six hours and P = 0.001 for other comparisons).. Transdermal diclofenac patch and EMLA are equally effective in reducing venous cannulation pain, but signs of erythema, induration and edema are less frequently observed with the transdermal diclofenac patch.

Topics: Adult; Anesthesia, Local; Anesthetics, Local; Catheterization, Peripheral; Diclofenac; Double-Blind Method; Female; Humans; Incidence; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Pain Measurement; Prilocaine; Veins

To evaluate the efficiency and tolerance of analgesic treatment with nitrous oxide and topical eutectic mixture of local anesthetics (EMLA) in children undergoing botulinum toxin injections for focal spasticity.. Prospective study including 40 consecutive patients aged 2 to 17 years, most with cerebral palsy, undergoing botulinum toxin injections. Ten had severe cerebral palsy with cognitive deficiency. For most patients the treatment involved several muscles, with several injections per muscle. The total number of injections varied from 1 to 25. The procedure was performed with topical anesthesia with EMLA and inhalation of nitrous oxide (50% nitrous oxide, 50% oxygen). Reactions were recorded by the staff (a practician, a nurse, an auxiliary staff member and an internist) and whether they related to the injection or were nonspecific.. A total of 45% of patients showed no clinical manifestation of pain; for 30%, reactions were crying and withdrawal directly related to the injections; and for 25%, manifestations seemed nonspecific and mainly related to overall anxiety and discomfort. In 3 patients, moderate side effects were observed (visual hallucinations and euphoria).. Nitrous oxide analgesic with topical EMLA was efficient for children undergoing botulinum toxin injections but remained insufficient for half of our patients, and modification of the protocol is needed in some cases. Precise evaluation of acute pain is difficult in children with major cognitive deficits. Clinical manifestations are related to pain but also to overall anxiety and stress.

Topics: Adolescent; Analgesics, Non-Narcotic; Anesthetics, Local; Botulinum Toxins, Type A; Cerebral Palsy; Child; Child, Preschool; Female; Humans; Injections, Intramuscular; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Neuromuscular Agents; Nitrous Oxide; Ointments; Pain; Prilocaine; Prospective Studies

We evaluated the potential role of an euctectic mixture of local anesthetic (EMLA) cream application before performing midhumeral block.. Sixty patients undergoing surgery distal to the elbow amenable to a humeral block were prospectively recruited for the study. The patients were randomly allocated to 1 of 3 groups: Group E: topical EMLA cream 60 min before block plus 2 mL IV normal saline 5 min before procedure; Group P: topical sham cream plus 2 mL IV normal saline, and Group S: topical sham cream plus 0.1 microg/kg of sufentanil in 2 mL solution IV. Pain experienced during skin puncture, and overall pain for the whole procedure were rated using a 100-mm visual analog scale (0: no pain to 100: worst pain).. Patients in Group E experienced less pain compared with those in Groups P and S (5 +/- 3 mm vs 33 +/- 20 mm and 30 +/- 18 mm, respectively, P < 0.0001). The pain experienced throughout the complete humeral block was more substantial in Group P than in Group E (P = 0.01).. The patients who received EMLA cream had less pain with needle puncture as well as throughout the performance of humeral block.

Topics: Administration, Topical; Adult; Aged; Anesthetics, Local; Double-Blind Method; Elective Surgical Procedures; Female; Humans; Humerus; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Nerve Block; Pain; Pain Measurement; Prilocaine; Prospective Studies; Wakefulness

We evaluated the efficacy of topical Myolaxin (capsaican ointment, Geno, Mumbai) ointment over EMLA (eutectic mixture of lignocaine, prilocaine; Neon, Goa) cream for attenuating venous cannulation pain in this prospective, randomised, double blind study. Sixty adult patients undergoing elective laparoscopic cholecystectomy were randomly assigned into two equal groups. Group I (EMLA) received EMLA cream, whereas Group II (Myolaxin) received Myolaxin ointment. For both groups the cream was applied at the venous cannulation site (dorsum of the non-dominant hand) one hour prior to venous cannulation and was covered with an occlusive dressing. Following venous cannulation patients were asked if they felt pain during venous cannulation. If the answer was yes, they were asked to rate the severity of venous cannulation pain using a VisualAnalogue Scale (VAS) of 0-10. The incidence of venous cannulation pain was similar between groups: in the EMLA group 65% (18/28) compared to 67% (20/30) in the Myolaxin group (P=0.19). The severity of pain (median VAS with inter quartile range) was also similar between the groups: in the EMLA group 1.5 (3) compared to 1.5 (2) in the Myolaxin group (P=0.46). As the topical application of Myolaxin ointment is cheaper than EMLA and has similar efficacy, it may be a suitable alternative for reducing the incidence and severity of venous cannulation pain.

Topics: Adolescent; Adult; Analgesics, Non-Narcotic; Anesthetics, Local; Capsaicin; Catheterization, Peripheral; Double-Blind Method; Female; Humans; Incidence; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Pain Measurement; Prilocaine; Prospective Studies; Statistics, Nonparametric; Veins

EMLA is a lidocaine/prilocaine cream used for topical analgesia in human pediatric patients. The purpose of this study was to establish the safety of EMLA in clinically ill cats, to measure systemic absorption and to determine whether EMLA reduced the need for sedation for the placement of jugular catheters. Thirty-one cats were randomized to either a placebo or EMLA cream group. Cream was applied to a 10 cm(2) area over the jugular vein, with 1h of occlusive dressing. Neither anesthetic was systemically absorbed in any cat, and no adverse clinical signs were observed. Struggling during catheter placement was less in the EMLA-treated cats compared to placebo, but did not reach significance (P = 0.06). Jugular catheters were successfully placed in 60% of EMLA-treated cats and 38% of placebo cats; this difference was not statistically significant and may not justify the added steps of EMLA cream administration for this purpose. However, EMLA does appear to be safe in clinically ill cats, and may be useful for other applications such as for skin mass removal or repeated venepuncture.

Topics: Analgesia; Anesthetics, Combined; Anesthetics, Local; Animals; Cat Diseases; Catheterization, Central Venous; Cats; Female; Jugular Veins; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Pain Measurement; Pain, Postoperative; Prilocaine

In many children routine blood samples are obtained by capillary sampling, a technique that appears to cause high levels of pain and distress in the child. Topical anaesthesia might alleviate the pain associated with capillary blood sampling but would it affect the blood sample?. a preliminary study to determine whether topical local anaesthetic would affect the values of commonly performed biochemical tests. 22 healthy adult volunteers were recruited; each volunteer acted as his or her own control. Ametop was applied to a socially clean digit and covered with an occlusive dressing. After 30 minutes the dressing was taken off and excess gel was removed using a cotton wool ball. Two capillary samples were obtained from each volunteer, one from the Ametop treated digit and one from a digit on the opposing hand. The samples were analysed for sodium, potassium, glucose, urea, alkaline phosphatase (ALP), aspartate aminotransferase (AST), alinine aminotransferase (ALT) and bilirubin using a Vitros Chemistry analyser. Statistical analysis was performed on the blood results using Student's paired t-test.. Sodium and potassium levels were significantly higher in the samples from digits with Ametop applied, and alkaline phosphatase was significantly lower.. The use of amethocaine gel (Ametop) appears to affect the results of both sodium and potassium in capillary blood samples and therefore it cannot be recommended as a suitable agent for topical anaesthesia prior to this procedure.

Topics: Administration, Cutaneous; Adult; Alanine Transaminase; Alkaline Phosphatase; Anesthetics, Local; Aspartate Aminotransferases; Bias; Blood Glucose; Blood Specimen Collection; Blood Urea Nitrogen; Capillaries; Gels; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Potassium; Prilocaine; Sodium; Tetracaine

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.

Topics: Adjuvants, Immunologic; Administration, Cutaneous; Adolescent; Adult; Anesthetics, Local; Attitude to Health; Clinical Nursing Research; Cross-Over Studies; Fear; Female; Humans; Injections, Intramuscular; Interferon beta-1a; Interferon-beta; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Multiple Sclerosis, Relapsing-Remitting; Ointments; Pain; Pain Measurement; Pilot Projects; Prilocaine; Single-Blind Method; Treatment Outcome

A formulation of a eutectic mixture of lidocaine-prilocaine (EMLA) changes basal skin perfusion. Its use for alleviating pain associated with the Mantoux test may modify the recruitment of sensitised lymphocytes and then the response to tuberculin test. Twenty-four healthy BCG-vaccinated volunteers (26.7+/-4.1 years) received on each forearm an intradermal injection of 10IU tuberculin, one of the forearms being randomly pre-treated for 1h with EMLA-patch 5%. Pain associated with the Mantoux test was evaluated using a visual analogue scale. The transversal diameter of the induration was read at 72h. Subjects with 6mm difference between diameters (i.e. twice the usual variation for a Mantoux test) were recorded. Results were compared using a paired t-test. When using lidocaine-prilocaine prior to the test, a three-fold decrease in pain was noted (p<0.0001). Reading of the test were not affected by the lidocaine-prilocaine application (p=0.26). Four subjects had 6mm or more difference between their two tests, two of them having an induration greater than 15mm with lidocaine-prilocaine. Lidocaine-prilocaine reduces significantly pain associated with the Mantoux test but does not normally affect the test reading. However, when the induration is more than 15mm, a control without lidocaine-prilocaine has to be considered.

Topics: Adult; Anesthetics, Local; BCG Vaccine; Drug Delivery Systems; Female; Forearm; Humans; Injections, Intradermal; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Prilocaine; Tuberculin; Tuberculin Test

Cardiac transplant recipients often anticipate and suffer varying degrees of discomfort during surveillance endomyocardial biopsy (EMBx). We performed a randomized, blinded, placebo-controlled trial to determine whether topical anesthetic was associated with reduced pain and to identify factors associated with increased pain perception during EMBx. In 225 EMBxs, use of the eutectic mixture of lidocaine and prilocaine (EMLA) decreased pain score (-7.3 compared with placebo; p = 0.04); the other significant predictors of increased pain scores were time to achieve access (+2.3 per minute; p = 0.001) and female gender (+12.7 compared with males; p = 0.003). Topical anesthetic cream is associated with decreased pain during EMBx, even after adjusting for other predictors of pain, including female gender and longer time to achieve access. A better understanding of the factors affecting pain during EMBx could improve the comfort level of this procedure.

Topics: Administration, Topical; Anesthetics, Local; Biopsy; Catheterization; Double-Blind Method; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Myocardium; Pain; Pain Measurement; Prilocaine; Sex Characteristics; Transplantation

The aim of the study was to determine the efficacy and adverse effects of intravenous (i.v.) ketamine sedation administered by nonanesthetist physicians for painful procedures.. A single-agent, procedural sedation protocol using titrated doses of ketamine i.v. (maximum 2 mg.kg(-1)) was conducted in outpatient pediatric oncology patients undergoing lumbar puncture (LP), bone marrow biopsy/aspiration (BMBx/A) or combination (LP/BMBx/A) in a tertiary care setting. The efficacy of analgesia and sedation (ability to perform the procedure), procedure duration, recovery time and the occurrence of adverse events are described.. Fifty-eight subjects of a median age of 5 years (1-13) and median weight of 20 kg (10.5-68) underwent 119 sedations. An LP was performed in 73% of cases, a BMBx/A in 13% and LP/BMBx/A in 13%. Efficacy was 100% and the mean dose of ketamine was 1.3 mg.kg(-1) (0.4). The mean duration of the procedure was 6.6 min (4.2) and the recovery time was 11 min (4-45). Two subjects (1.7%) had a hypoxemia (SpO2 of <94%). No major airway complications occurred. The prevalence of hypertension (systolic > 20% at 5 min) was 54%. The median pain visual analogue score (VAS) for an observer was 0 (range 0-3) and caregiver was 0 (range 0-4). The median VAS for satisfaction (observer) was 10 (range 7-10) and caregiver VAS was also 10 (range 5-10). At 24 h after discharge, the incidence of bad dreams was 3.3%; vomiting, 10.8%; and abnormal behavior, 4.2%.. Ketamine i.v. up to 2 mg.kg(-1) is an effective sedative for oncology procedures using a defined protocol.

Topics: Adolescent; Analgesics; Anesthetics, Local; Biopsy, Needle; Bone Marrow Examination; Child; Child, Preschool; Dose-Response Relationship, Drug; Female; Humans; Infant; Injections, Intravenous; Ketamine; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Pain Measurement; Patient Satisfaction; Prilocaine; Spinal Puncture; Tetracaine; Treatment Outcome

Topics: Anesthetics, Combined; Anesthetics, Local; Catheterization; Child; Double-Blind Method; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Pain Measurement; Prilocaine; Prospective Studies

The injection of local anesthesia before upper lid blepharoplasty is perceived as unpleasant and painful by some patients.. In an intraindividual randomized prospective study, 14 patients undergoing upper lid blepharoplasty on both sides were examined. Before the operation the EMLA creme was put on one side. The pain sensibility was checked before and after using EMLA creme and during the infiltration of anesthesia and the operation.. The sensitivity before putting on EMLA creme was equal in all patients on both sides. After application there was a distinct difference between the sides. During the infiltration of anesthesia 12 patients reported low and 2 patients medium pain on the treated side, while on the non-treated side 5 patients reported low, 4 patients medium, and 5 patients severe pain.. Applying EMLA creme before an operation reduces the pain sensitivity during infiltration of anesthesia and during the operation.

Topics: Administration, Topical; Anesthetics; Anesthetics, Local; Blepharoplasty; Chemotherapy, Adjuvant; Female; Humans; Injections; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Pain Measurement; Preoperative Care; Prilocaine; Treatment Outcome

Laser hair removal is an effective therapy for the treatment of hirsutism, hypertrichosis, and pseudofolliculitis barbae. Although side effects are uncommon, pain is described by most patients undergoing long-pulsed neodymium:yttrium-aluminum-garnet (Nd:YAG) 1,064 nm laser therapy.. To compare the efficacy of topical eutectic mixture of local anesthetics (EMLA) versus topical lidocaine (LMX) in pain control for Nd:YAG 1,064 nm laser hair removal.. Sixty-four patients were enrolled in a double-blind randomized study over a 6-month period. Each patient had half of the treatment area covered with EMLA and the other half with LMX 30 minutes prior to treatment. Neither was applied under occlusion. Immediately following their treatment session, patients completed a visual analog pain scale.. There was no statistically significant difference in pain control between EMLA and LMX. However, female test subjects demonstrated lower pain scores than male test subjects.. Nd:YAG 1,064 nm laser hair removal is a painful procedure. Topical anesthetics have been proven to reduce pain for laser hair removal. There is no statistically significant difference between the two most commonly used topical anesthetics for pain control in laser hair removal. Therefore, cost and minimizing potential side effects should guide the physician in selecting the appropriate anesthetic.

Topics: Anesthetics, Combined; Anesthetics, Local; Double-Blind Method; Female; Hair Removal; Humans; Laser Therapy; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Pain Measurement; Prilocaine; Sex Factors

To investigate the effect and usefulness of Eutectic Mixture of Local Anesthetic (EMLA) applied with an occlusive dressing and used simultaneously with a low dose of fentanyl during shockwave lithotripsy (SWL).. One hundred sixty patients with kidney stones, aged between 19 and 68 years, were randomly divided into seven groups that were treated as follows: group 1: fentanyl 1 microg/kg by intravenous infusion (IV); group 2: IV fentanyl 0.25 microg/kg; group 3: occlusive dressing and IV fentanyl 0.25 microg/kg; group 4: placebo cream and IV fentanyl 0.25 microg/kg; group 5: EMLA cream and IV fentanyl 0.25 microg/kg; group 6: placebo cream and IV fentanyl 0.25 microg/kg with an occlusive dressing; and group 7: EMLA cream and IV fentanyl 0.25 microg/kg with an occlusive dressing. The mean arterial pressure (MAP), heart rate, ventilatory rate, and oxygen saturation (SpO(2)) were recorded on all patients. A visual analog scale 0-100 mm (VAS) was used for the evaluation of pain. The skin integrity was inspected to detect any lesions after SWL.. The SpO(2) in group 1 was lower statistically than in the other groups. The VAS score in group 7 was clearly lower than in the others in the first, tenth, and twentieth minutes and at the end of SWL. In groups 6 and 7, additional fentanyl doses were lower than in the other groups, but only in group 7 was the total fentanyl dosage low. Skin lesions were not seen only in groups 3, 6, and 7.. Use of EMLA and an occlusive dressing with low doses of fentanyl during SWL provides appropriate analgesia with minimal morbidity.

Topics: Administration, Topical; Aged; Analgesics, Opioid; Anesthetics, Local; Drug Therapy, Combination; Female; Fentanyl; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Lithotripsy; Male; Middle Aged; Occlusive Dressings; Pain; Prilocaine; Urinary Calculi

The aims of the present study were to evaluate the efficacy of eutectic mixture of local anesthetics (EMLA) cream in transrectal-guided prostate biopsy and to compare its effect with that of other injectable anesthetic procedures.. Eighty male patients with prostate-specific antigen (PSA) levels > 4 ng/ml or who had prostate nodules on digital rectal examination were randomly divided into four groups. In Group 1 (controls), prostate biopsy was performed after application of a placebo cream. In Group 2, local surface anesthesia with EMLA cream was performed 15 min before biopsy. Periprosthetic nerve blockade was performed with 1% prilocaine and 1% lidocaine in Groups 3 and 4, respectively. Pain was evaluated using a visual analog scale (VAS) after each core biopsy. In addition, blood pressure, heart rate and oxygen saturations were recorded after each biopsy and then at 5-min intervals for 15 min.. Average VAS scores in Groups 1-4 were 5.5, 2.9, 2.4 and 2.2, respectively. There was a statistically significant difference in VAS scores between the treatment groups and the placebo group (p = 0.000). There were no statistically significant differences in VAS scores between the three treatment groups (p2-3 = 0.126, p2-4 = 0.303, p3-4 = 0.537). We detected no statistically significant differences between the groups based on the hemodynamic data (pMAP = 0.899). Moreover, these measurements did not show statistically significant changes with time in any of the groups (p > 0. 05).. Intrarectal application of EMLA cream provides equal anesthesia to periprostatic nerve blockade with prilocaine and lidocaine.

Topics: Administration, Rectal; Aged; Anesthesia, Local; Anesthetics, Local; Biopsy; Endosonography; Humans; Injections; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Ointments; Pain; Pain Measurement; Prilocaine; Prostate; Prostate-Specific Antigen; Prostatic Neoplasms; Rectum

The aim of the study was to compare the analgesic effect of a topical benzocaine gel with that of a topical gel mixture of lidocaine/prilocaine (L/P).. Forty individuals took part in the study. Topical anesthetics were applied bilaterally in the maxillary vestibule lateral to the canine. On one side, a mixture of 2.5% lidocaine/2.5% prilocaine (EMLA) was applied. On the opposite side, 20% benzocaine (Topex) was applied as control. The patients had no knowledge as to which side each gel was applied. A 27-gauge needle was inserted through the mucosa to bone contact every minute during a seven-minute period in each area of application. The subjects recorded which side was the least painful, and also registered the grade of pain on a 100 mm VAS scale. Comparisons were made estimating the group difference using the Wilcoxon rank sum test.. After one minute, 87.5% of the subjects reported the L/P side being the least painful. After two to four minutes, 97.5-100% reported the L/P side least painful. After five to seven minutes, 90-95% reported the L/P side least painful. The VAS grading of the pain showed that L/P was significantly (p < 0.05) better in eliminating or reducing the pain.. Topical anesthetics based on a combination of lidocaine 2.5% + prilocaine 2.5% are significantly more effective than 20% benzocaine in reducing pain from needle stick in the maxillary vestibular mucosa.

Topics: Adult; Anesthetics, Combined; Anesthetics, Local; Benzocaine; Cuspid; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Mouth Mucosa; Needles; Pain; Pain Measurement; Patient Satisfaction; Prilocaine; Time Factors

To evaluate the efficacy and safety of nitrous oxide treatment given to children presenting procedural problems in a paediatric outpatient department.. The study comprised 70 children 6-18 years old. Two different groups were studied. (1) Children presenting with problems in establishing venous cannulation (VC) (n = 50). The patients were randomised to conventional treatment (CO); cutaneous application of EMLA or nitrous oxide treatment (NO); N2O and EMLA. (2) Anxious children/children undergoing painful procedures who repeatedly come to the clinic (n = 20). These children underwent two procedures with CO/NO, the order of priority being randomised. Altogether the study included 90 procedures. Main outcome measures were procedure time, number of attempts required to establish VC, pain, and evaluation.. All procedures were performed with NO while four VC (8%) were not possible to perform with CO. The number of attempts required to establish VC was lower when using NO (median 2, range 2-9), compared with CO (median 4, range 2-9). The estimated pain was lower with NO. The total mean time required was similar for NO and CO when the time required for the NO procedure was included. One complication, tinnitus, was observed; it disappeared within 3 minutes.. The pretreatment with nitrous oxide is a time effective and safe method for use at paediatric outpatient departments to reduce pain, facilitate venous cannulation, and thereby reduce the number of costly cancellations of planned procedures.

Topics: Adolescent; Analgesics; Anesthetics, Inhalation; Anxiety; Catheterization; Child; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Nitrous Oxide; Ointments; Outpatients; Pain; Pediatrics; Prilocaine; Statistics, Nonparametric

To assess the effectiveness of perianal and intrarectal lidocaine-prilocaine cream for prostate biopsy.. In a prospective, randomized, double-blind, placebo-controlled study, 200 consecutive patients were randomized to receive 5 mL lidocaine-prilocaine cream or 5 mL placebo peri-anally and transrectally before transrectal ultrasonography (TRUS)-guided prostate needle biopsy (mean number of cores, 12). The men were asked to grade the pain when the TRUS probe was inserted and during the biopsy procedure using a 10-point linear visual analogue pain scale.. At probe insertion, men in the anaesthetic group reported a significantly lower mean pain level than men in the placebo group (0.3 vs 1.6, P < 0.001). Men who had anaesthetic also reported less pain during biopsy punctures (1.8 vs 3.2, P < 0.001). Stratifying results by age, younger men (< 67 years) benefited more from anaesthesia during probe insertion (0.9 vs 1.7; P = 0.04) and biopsy (1.8 vs 4.0, P < 0.001) than older men (1.0 vs 1.1, P = 0.7 and 1.9 vs 2.4, P = 0.3, respectively). There were only minor complications, and these were not significantly different between the groups.. Topical anaesthesia with prilocaine-lidocaine cream significantly reduced pain at transrectal probe insertion and during the biopsy procedure.

Topics: Adult; Aged; Aged, 80 and over; Anesthetics, Combined; Anesthetics, Local; Biopsy, Needle; Double-Blind Method; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Ointments; Pain; Pain Measurement; Pain, Postoperative; Prilocaine; Prospective Studies; Prostate; Prostatic Neoplasms; Ultrasonography, Interventional

Prostate biopsy is usually performed without anesthesia. We evaluated the patient's perception of pain/discomfort experienced during the procedure in terms of the type of anesthesia used: periprostatic infiltration with 2% lidocaine, or intrarectal instillation of lidocaine-prilocain cream. A total of 198 patients were divided into three groups: group 1 (control group, n=40) received sonographic gel intrarectally prior to biopsy, group 2 (n=75) were given intrarectal instillation of lidocaine-prilocain cream, and group 3 (n=80) received periprostatic anesthesia by injecting 10 ml of 2% lidocaine. Pain after each biopsy was assessed using an 11-point linear visual analog pain scale. The mean pain scores were 5.1 in group 1, 4.8 in group 2, and 2.5 in group 3, resulting in a significant difference between group 3 and both groups 1 and 2, but not between groups 1 and 2. The incidence of biopsy-related adverse events did not differ among groups. Transrectal ultrasonographic guided periprostatic anesthesia is superior to intarectal instillation of lidocaine-prilocain cream.

Topics: Aged; Aged, 80 and over; Anesthesia, Local; Anesthetics, Combined; Anesthetics, Local; Biopsy; Dosage Forms; Humans; Instillation, Drug; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Prilocaine; Prostate; Ultrasonography

Eutectic mixture of local anaesthetic cream and lidocaine iontophoresis are effective in providing analgesia for peripheral venous cannulation with small gauge cannulae in adults and children. The objective of this study was to compare the analgesic efficacy of the two techniques directly in patients using larger cannulae.. In a double-blind, randomized, controlled study we compared the two techniques directly. Twenty-eight patients had the eutectic mixture of local anaesthetic cream applied to the dorsum of one hand for 60 min followed by sham iontophoresis (group EMLA); the other hand had a sham cream applied for 60 min followed by 10 min of 2 mA iontophoresis with lidocaine 4% and epinephrine 1 in 50,000 (group iontophoresis). Within 5 min of completion of iontophoresis an anaesthetist, unaware of treatment allocation, inserted 18-G venous cannulae into veins of both hands. The patient then scored the amount of pain on cannulation using a 10 point verbal rating scale.. Eight patients were excluded from analysis due to failed cannulation (two group EMLA, two group iontophoresis), intolerable burning sensation from iontophoresis (one), protocol violation (one), and changes in surgical schedule (two). Pain scores were lower for the EMLA treated hand than for the iontophoresis side (median (range) 1 (0-7) vs. 3 (0-6); P = 0.023). Erythema and paraesthesia were common but short lived on the iontophoresis side.. Although lidocaine iontophoresis is effective more quickly than the eutectic mixture of local anaesthetic cream, the superior quality of analgesia produced by the eutectic mixture in this study should be borne in mind if these treatments are used electively.

Topics: Adult; Aged; Analgesia; Anesthetics, Combined; Anesthetics, Local; Catheterization, Peripheral; Double-Blind Method; Erythema; Female; Hand; Humans; Iontophoresis; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Ointments; Pain; Pain Measurement; Paresthesia; Placebos; Prilocaine; Pruritus

ELA-Max and EMLA cream are topical anesthetics that have been shown to have similar anesthetic efficacy in previous studies.. To evaluate the analgesic efficacy of ELA-Max in comparison with EMLA cream using a novel method of thermosensory threshold analysis.. A thermosensory analyzer was used to assess warmth- and heat-induced pain thresholds.. No statistically significant difference was found in pain thresholds using either formulation. However, EMLA cream increased the heat-induced pain threshold to a greater extent than ELA-Max. Thermosensory measurement and analysis was well tolerated and no adverse events were encountered.. EMLA cream may be superior to ELA-Max for heat-induced pain. This study suggests that thermosensory measurement may be another suitable tool for future topical anesthetic efficacy studies.

Topics: Administration, Cutaneous; Adult; Anesthetics, Local; Double-Blind Method; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Pain Measurement; Pilot Projects; Prilocaine; Skin; Treatment Outcome

To compare the analgesic effects of non nutritive pacifier sucking, oral administration of a 30% saccharose solution, local application of Emla and their association for subcutaneous injection of erythropoietin (EPO) in preterm infants.. Our study was a randomised, prospective study conducted over 5 months. Neonates with a gestational age below 33 weeks of gestation and older than 8 days of life were included if they were treated with EPO (three subcutaneous injections per week during 6 weeks). For each consecutive EPO injection, patients were randomised between four groups of intervention: non nutritive pacifier sucking (T), oral administration of 0.2-0.5 ml of a 30% saccharose solution with non nutritive pacifier sucking (S), local application of Emla with non nutritive pacifier sucking (E), and oral administration of 0.2-0.5 ml of a 30% saccharose solution with local application of Emla and with non nutritive pacifier sucking (S + E). Each child was its own control. Pain was assessed with the Newborn Acute Pain scale (DAN) and with the Neonatal Facial Coding System (NFCS).. Thirty-three neonates were included, representing 265 injections. Distribution was: 41 in group T, 71 in group E, 86 in group S and 67 in group E + S. Mean DAN and NFCS scores were statistically different between groups T, E and S. Analgesic effect of saccharose (-1.05) was greater than Emla (-0.56). Used together, effects were adding up without potentialisation.. This study shows that the association of non nutritive pacifier sucking with oral administration of saccharose and local application of Emla has a better analgesic effect than each of these three interventions alone for subcutaneous injection of EPO.

Topics: Administration, Cutaneous; Administration, Oral; Analysis of Variance; Anesthetics, Combined; Anesthetics, Local; Combined Modality Therapy; Drug Therapy, Combination; Erythropoietin; Facial Expression; Female; Gestational Age; Humans; Infant, Newborn; Infant, Premature, Diseases; Injections, Subcutaneous; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pacifiers; Pain; Pain Measurement; Prilocaine; Prospective Studies; Solutions; Sucking Behavior; Sucrose; Treatment Outcome

Although the equimolecular mixture of oxygen and nitrous oxide (EMONO) seems a good choice to relieve procedure-related pain in children, it has not been evaluated for insertion of central venous catheters in children. To assess the safety and the effectiveness of this gas mixture for insertion of central venous catheters, we conducted a prospective observational study.. This study was performed by the "Centre National de Greffe de Moelle Osseuse." Procedure and inhalation characteristics, as well as pain evaluations and side effects, were reported.. Fifty central venous catheters were inserted in 50 consecutive children. Median age was 7 (range, 4-13) years. An anesthesiologist was responsible for delivering EMONO, and provided constant surveillance throughout the procedure. EMLA cream was applied 2 hr before EMONO inhalation. No associated drugs were used. All catheters were inserted by the same experienced physician in the operating theater. Median inhalation length was 5 min (range, 3-6) before starting catheter's insertion and 12 min (range, 9-25) for the total inhalation. Median procedural pain evaluations were 10 (range, 0-30) for children on a 0-100 visual analog scale (VAS). Minor side effects were observed during eight (16%) inhalations. These side effects were euphoria (14%), deep sedation (4%), nausea and vomiting (2%), hallucinations (2%). All side effects were transient and resolved within 5 min after removing the inhalation device.. This study which shows that EMONO is effective for insertion of central venous catheters in children and represents a simple and safe alternative to general anesthesia.

Topics: Adolescent; Age Distribution; Catheterization, Central Venous; Child; Child, Preschool; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Nitrous Oxide; Oxygen; Pain; Pain Measurement; Prilocaine

Three efficacy studies, comprising a database of 337 subjects, were conducted as part of the clinical evaluation of the noninjectable anesthetic gel Oraqix (AstraZeneca, Södertälje, Sweden). The authors discuss some of the challenges encountered when they interpreted the results of the clinical studies and present the results from an alternative analysis of the anesthetic efficacy.. The three multicenter studies were double-blind, randomized and placebo-controlled. Clinicians applied gel in the subjects' periodontal pockets before scaling and/or root planing, or SRP. Subjects recorded overall pain on a 100-millimeter visual analog scale, or VAS. In the studies, the evaluation of the anesthetic efficacy was based on absolute treatment difference (active-placebo). Investigators used an alternative post hoc approach to evaluate the effect expressed as a ratio (active:placebo).. The studies demonstrated consistent and significant lower pain scores for the anesthetic gel versus the placebo gel, with point estimates of absolute treatment difference being 8, 4 and 10 mm. The alternative analysis verified that the estimated treatment effect in terms of a ratio was close to 50 percent in all three studies.. Treatment effects of the anesthetic gel relative to the placebo gel were described more appropriately by means of ratios instead of absolute differences. In this sample of 337 subjects, it was shown that pain was reduced by 50 percent when the anesthetic gel was used compared with when the placebo gel was used.. The authors found that the anesthetic periodontal gel is effective in reducing pain resulting from SRP.

Topics: Adult; Aged; Aged, 80 and over; Anesthetics, Combined; Anesthetics, Local; Dental Scaling; Double-Blind Method; Female; Gels; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Ointments; Pain; Pain Measurement; Periodontal Pocket; Periodontitis; Placebos; Prilocaine; Root Planing; Treatment Outcome

To compare the efficacy of 3 different pharmacologic regimens to relieve pain and distress in children with cancer undergoing bone marrow aspirations (BMAs) and lumbar punctures (LPs).. Retrospective cohort study with crossovers for some patients.. The pain and distress ratings of patients undergoing BMAs (n = 73) and LPs (n = 105) were examined in a comparison of 3 different interventions: (1) a topical eutectic mixture of lidocaine and prilocaine (EMLA cream), (2) oral midazolam and EMLA cream, or (3) propofol/fentanyl general anesthesia. The choice of the intervention depended on patient/parent request. A validated faces pain scale was completed by the child or parent following each BMA or LP. The faces pain scale includes ratings of the severity of pain (from 0 = none to 5 = severe) and ratings of how frightened (from 0 = not scared to 5 = scared) the child was prior to each procedure. Comparisons of the pain and distress ratings were made among all patients for their first procedure and also within individual patients who had received >1 of the 3 interventions. Independent comparisons between the first treatments received by each patient were analyzed using Kruskal-Wallis tests. Comparisons of different crossover treatments received by individual patients were analyzed using Wilcoxon tests.. For all first procedures, mean +/- SD pain and distress ratings during LPs were significantly lower when propofol/fentanyl was used (n = 43; 0.4 +/- 1.0 and 1.4 +/- 1.7) versus either EMLA (n = 29; 2.4 +/- 1.7 and 2.9 +/- 1.9) or midazolam/EMLA (n = 33; 2.4 +/- 1.8 and 2.7 +/- 1.8), respectively. Pain and distress ratings during BMAs were also significantly lower with propofol/fentanyl (n = 29; 0.5 +/- 1.0 and 1.2 +/- 1.7) versus EMLA (n = 21; 3.5 +/- 1.6 and 3.3 +/- 1.8) or midazolam/EMLA (n = 23; 3.3 +/- 1.5 and 3.0 +/- 1.9), respectively. When data were analyzed within each patient, these differences were also present.. Children receiving propofol/fentanyl general anesthesia experienced significantly less procedure-related pain and distress than did those receiving either EMLA or oral midazolam/EMLA.

Topics: Adolescent; Anesthetics, Combined; Anesthetics, Intravenous; Anesthetics, Local; Biopsy, Needle; Bone Marrow Examination; Child; Child, Preschool; Cross-Over Studies; Drug Administration Routes; Female; Fentanyl; Humans; Infant; Leukemia; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Midazolam; Pain; Prilocaine; Propofol; Retrospective Studies; Spinal Puncture

To evaluate the efficacy of eutectic lidocaine/prilocaine cream (EMLA) in reducing the pain associated with steroid joint injection in children with juvenile arthritis.. A randomized, double blind, placebo controlled parallel group trial. Thirty-one children (ages 8-18 yrs) scheduled for steroid injection into a knee were randomized into groups having either 2.5 g lidocaine/prilocaine cream or placebo cream applied to the injection site 60-90 min before the procedure. Patients assessed the pain associated with initial needle insertion and subsequent steroid injection using a 10 cm visual analog scale.. No significant difference was found in the pain reported after needle insertion or steroid injection between the lidocaine/prilocaine cream group (n = 17) and the placebo group (n = 14). There was a trend toward an association of lower median scores with the pain of steroid injection in the lidocaine/prilocaine group (6 mm) compared with the placebo group (22 mm).. Application of 2.5 g lidocaine/prilocaine cream for 60-90 min had no statistically significant analgesic effect on pain associated with injections of steroids into the knees of children with juvenile arthritis.

Topics: Adolescent; Anesthetics, Local; Anti-Inflammatory Agents; Arthritis, Juvenile; Child; Double-Blind Method; Female; Humans; Injections, Intra-Articular; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Patient Satisfaction; Placebos; Prilocaine; Steroids

EMLA cream is the current technique of choice to reduce pain during venous cannulation in most paediatric practice. Its use is limited by logistic arrangements and failure to improve cooperation and allay anxiety. Nitrous oxide (N2O) would appear to be an effective alternative. A combination technique may be useful in selected patients.. One hundred and twenty unpremedicated ASA 1 and 2 day surgery patients, aged 8-15 years were randomized into group 1 (EMLA + air/O2), group 2 (50% N2O/50% O2) and group 3 (EMLA + 50% N2O/50% O2). All patients underwent cannulation on the dorsum of the hand with a 22-G intravenous catheter. Pain behaviour before cannulation was assessed by an observer with Children's Hospital of Eastern Ontario Pain Scale (CHEOPS). Pain during cannulation was evaluated with CHEOPS by an observer and Visual Analogue Scale (VAS) (0-100 mm) by the patient. Satisfaction score (0-100%) for the experience were reported by the patient. Degree of ease of cannulation, time for cannulation were assessed. Heart rate, oxygen saturation were compared before, during and after cannulation.. The self-reported VAS for group 3 (10.10 +/- 14.99) was significantly lower than group 1 (26.13 +/- 27.59) and group 2 (18.35 +/- 18.11) (P = 0.003). No significant difference existed between VAS for group 1 and 2. There were also significantly more patients with VAS = 0 in group 3 (23/40) versus group 2 (11/40) versus group 1 (10/40), P = 0.004. The satisfactory score in group 3 (93 +/- 9.96) was significantly higher (P = 0.039) than group 1 (81.13 +/- 24.61) and group 2 (84 +/- 22.02). The increase in CHEOPS from before to during cannulation was significant only in group 1 (P = 0.002). There was no significant difference between frequency of patients with side-effects, ease of cannulation and time taken for cannulation in the three groups.. EMLA and 50% N2O are equally effective for pain reduction while a combination technique provides superior analgesia and satisfaction. N2O has an advantage over EMLA in reduction of pain related behaviour in older children.

Topics: Adolescent; Analysis of Variance; Anesthetics, Combined; Anesthetics, Inhalation; Anesthetics, Local; Anxiety; Catheterization, Peripheral; Child; Child Behavior; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Nitrous Oxide; Pain; Pain Measurement; Prilocaine

Retrobulbar injection can be associated with significant pain, due to both needle insertion and deposition of the local anaesthetic solution. The local anaesthetic cream EMLA (eutectic mixture of local anaesthetics) which contains a mixture of lignocaine and prilocaine has been shown to reduce the pain associated with skin puncture. The efficacy of EMLA in alleviating the pain of retrobulbar injection for cataract surgery was assessed in this study.. In this, randomised double-blind study, EMLA (n = 53) or lignocaine 5% ointment (n = 50) was administered to the inferior orbital margin at least 45 min before retrobulbar block in 103 patients. Pain assessed during retrobulbar block was marked subjectively by the patient on a 10-point numerical rating scale.. Median verbal pain scores were 3.0 with an interquartile range of 1.5-6.5 in the control group and 3.50 with an interquartile range of 2.0-6.0 in the EMLA(R) group (P = 0.67). There was no significant difference between the EMLA group and the lignocaine ointment group according to this pain assessment.. EMLA does not permit pain-free retrobulbar injection.

Topics: Administration, Topical; Anesthesia, Spinal; Anesthetics, Local; Cataract Extraction; Double-Blind Method; Female; Humans; Injections; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Ointments; Pain; Pain Measurement; Prilocaine

We conducted two studies to determine whether the minimum clinically significant difference in the visual analog scale (VAS) for nearly simultaneous and brief-interval serial assessments of pain is less than that for pain assessment at 20- to 30-minute intervals, using a 10-cm VAS. The first study was a blinded, randomized, placebo-controlled paired trial comparing the pain of intravenous cannulation in both hands (20-minute application of a eutectic mixture of local anesthetics v placebo) of study subjects. The second study was a non-blinded, randomized, paired trial of different treatments for jellyfish stings. In the first study, 37 of 40 subjects indicated that one hand experienced more pain than the other. Eleven of these 37 subjects (30%) indicated differences in VAS values of 1.0 cm or less, with a minimum value of 0.5 cm. In the second study, for all the VAS-based pain comparisons, VAS differences of

Topics: Administration, Topical; Adult; Anesthetics, Local; Bites and Stings; Catheterization, Peripheral; Cubozoa; Double-Blind Method; Forearm; Hand; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Pain Management; Pain Measurement; Prilocaine; Sensitivity and Specificity; Time Factors

The objective of this study is to determine whether use of lidocaine-prilocaine 5% cream (EMLA) and oral glucose decreases pain associated with diphteria-pertussis-tetanus (DPT) immunization in 3-month-old infants.. randomized, double-blind, controlled trial in outpatient paediatric practice in northern Sweden. EMLA or placebo was applied to the infant's lateral region of the right thigh and covered with an occlusive dressing 1h before the immunization. In addition, 1 ml of glucose (300 mg/ml) or placebo (water) was instilled on the baby's tongue within 2 min before the DPT-injection. Forty-five infants received EMLA and glucose and 45 infants placebo cream and water. ECG was recorded and stored in a computer and the procedure was videotaped. The parents and the nurse assessed the infants' pain on a visual analogue scale (VAS) after the immunization. Heart rate and heart rate variability pre- and post-injection were calculated. From the videotapes, the modified behavioural pain scale (MBPS) was used to assess pain scores during baseline and after immunization. The latency of the first cry and total crying time were measured. The parents and the nurse scored the infants' pain on the VAS significantly lower in the treatment group than in the placebo group. The infants' responses to the immunization measured as the difference in MBPS scores pre- and post-injection were significantly lower in the EMLA-glucose group compared with the placebo group. More infants cried after the immunization in the placebo group compared with the EMLA-glucose group and the latency of the first cry after the injection was shorter in the placebo group. A biphasic transient heart rate response with a marked deceleration followed by a subsequent acceleration was seen more frequently in the placebo group compared to the EMLA-glucose group. EMLA and glucose alleviate immunization pain in 3-month-old infants.

Topics: Administration, Oral; Administration, Topical; Analysis of Variance; Chi-Square Distribution; Double-Blind Method; Drug Therapy, Combination; Female; Glucose; Heart Rate; Humans; Immunization; Infant; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Pain Measurement; Prilocaine

Topical anesthesia using 60% lidocaine tape reduces the incidence of propofol injection pain. We conducted a randomized prospective double-blinded placebo-controlled study to assess the analgesic efficacy of pretreatment with topical 5% lidocaine-prilocaine (EMLA) cream in 90 ASA physical status I and II adult patients scheduled to undergo day-case gynecological surgery. Propofol injection pain was not reduced by pretreatment with EMLA cream, whereas the addition of lidocaine to propofol did significantly reduce propofol injection pain compared with the control group (P = 0.002). We conclude that topical anesthesia with EMLA cream applied for 60 min does not significantly reduce propofol injection pain.

Topics: Administration, Topical; Adolescent; Adult; Aged; Ambulatory Surgical Procedures; Anesthetics, Combined; Anesthetics, Intravenous; Anesthetics, Local; Double-Blind Method; Female; Gynecologic Surgical Procedures; Humans; Injections, Intravenous; Lidocaine; Lidocaine, Prilocaine Drug Combination; Middle Aged; Ointments; Pain; Pain Measurement; Prilocaine; Propofol

Quality aspects of the anesthetic process are reflected in the rate of intraoperative adverse events. The purpose of this report is to illustrate how the quality of the anesthesia process can be analyzed using statistical process control methods, and exemplify how this analysis can be used for quality improvement.. We prospectively recorded anesthesia-related data from all anesthetics for five years. The data included intraoperative adverse events, which were graded into four levels, according to severity. We selected four adverse events, representing important quality and safety aspects, for statistical process control analysis. These were: inadequate regional anesthesia, difficult emergence from general anesthesia, intubation difficulties and drug errors. We analyzed the underlying process using 'p-charts' for statistical process control.. In 65,170 anesthetics we recorded adverse events in 18.3%; mostly of lesser severity. Control charts were used to define statistically the predictable normal variation in problem rate, and then used as a basis for analysis of the selected problems with the following results: Inadequate plexus anesthesia: stable process, but unacceptably high failure rate; Difficult emergence: unstable process, because of quality improvement efforts; Intubation difficulties: stable process, rate acceptable; Medication errors: methodology not suited because of low rate of errors.. By applying statistical process control methods to the analysis of adverse events, we have exemplified how this allows us to determine if a process is stable, whether an intervention is required, and if quality improvement efforts have the desired effect.

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents, Non-Steroidal; Catheterization, Peripheral; Edema; Erythema; Female; Gels; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Pain Measurement; Piroxicam; Prilocaine

To evaluate and compare the analgesic efficacy and anti-inflammatory effects of topical piroxicam gel vs eutectic mixture of local anesthetic (EMLA) cream applied to the peripheral venous cannulation site in adult volunteers.. Piroxicam gel and EMLA cream were randomly applied on the dorsum of the right and left hand of ten volunteers who acted as their own control. A venous cannula was inserted (no iv infusion) and removed after one hour. Pain scores and signs of inflammation were noted at the cannulation site up to 48 hr.. Pain scores with piroxicam gel were higher on cannulation and on advancement of the cannula (P < 0.05). Thereafter, pain scores were significantly higher with EMLA (P < 0.05). Blanching was present at all the peripheral venous sites treated with EMLA cream. Signs of inflammation (erythema, edema) were not more frequent with EMLA than with piroxicam (P > 0.05). Induration was more frequent with EMLA at six hours.. In volunteers EMLA cream is associated with less pain on cannulation and cannula advancement compared to piroxicam gel. Topical application of piroxicam gel before peripheral venous cannulation alleviates pain and, possibly, inflammation in the period subsequent to cannulation itself.

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents, Non-Steroidal; Catheterization, Peripheral; Edema; Erythema; Female; Gels; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Pain Measurement; Piroxicam; Prilocaine

Laser resurfacing has become a popular modality for the treatment of photodamaged skin, rhytids, and acne scarring. In many cases, this procedure is performed under general anesthesia or intravenous sedation in conjunction with nerve blocks and local infiltration.. To evaluate the safety and efficacy of facial carbon dioxide laser resurfacing using a supplemented topical anesthesia protocol.. Nonrandomized case series of patients observed for 1 year.. Outpatient surgery center.. Two hundred consecutive patients undergoing treatment for facial rhytids or acne scarring. Intervention Full-face carbon dioxide laser resurfacing procedures were performed using a supplemented topical anesthesia protocol. Pretreatment medications included diazepam, oral analgesics, and intramuscular ketorolac tromethamine.. Tolerability of procedure, healing times, and adverse effects.. Topical anesthesia provided effective and sufficient anesthesia in most cases. Only 10 of 200 patients required additional anesthesia (regional nerve blocks and/or local infiltration). Substantial improvement of rhytids, photodamage, and acne scarring was observed. Posttreatment hypopigmentation was seen in 1 patient. Scarring was not observed. Conclusion A supplemented topical anesthesia protocol for full-face laser resurfacing is a safe and effective alternative to traditional anesthesia strategies.

Topics: Acne Vulgaris; Administration, Topical; Anesthetics, Local; Cicatrix; Face; Female; Follow-Up Studies; Humans; Laser Therapy; Lasers; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Patient Satisfaction; Prilocaine; Skin Aging; Time Factors; Treatment Outcome

To determine the efficacy of a topical anesthetic cream, eutectic mixture of local anesthetics (EMLA), in alleviating pain associated with lumbar puncture in newborns.. Randomized double-blind placebo-controlled trial.. Neonatal intensive care unit of a university teaching hospital. Patients Sixty consecutive newborns (gestational age, >or=34 weeks) undergoing diagnostic lumbar puncture. Intervention Topical application of 1 g of EMLA or placebo 60 to 90 minutes before lumbar puncture.. Heart rate, transcutaneous oxygen saturation level, and total behavioral score recorded on a video camera and graded according to the Neonatal Facial Coding System.. Compared with baseline, all newborns experienced pain as evidenced by increased heart rate, decreased oxygen saturation level, and total behavioral score (all within-groups differences were significant using repeated-measures analysis of variance; P<.001) during the procedure. Compared with placebo, EMLA significantly attenuated the pain response as shown by a lower mean +/- SE heart rate (per minute), particularly at needle insertion (EMLA: 159.3 +/- 2.3; placebo: 175.2 +/- 2.7; P<.001) and needle withdrawal (EMLA: 153.8 +/- 2.6; placebo: 167.3 +/- 2.5; P<.001), and a lower mean +/- SE total behavioral score, again at insertion (EMLA: 4.0 +/- 0.3; placebo: 5.0 +/- 0.0; P =.004) and withdrawal (EMLA: 1.8 +/- 0.3; placebo: 3.9 +/- 0.3; P<.001). There was no statistically significant difference between groups with regard to oxygen saturation level.. Lumbar puncture in newborns produces pain responses. Eutectic mixture of local anesthetics is an efficacious agent for reducing the pain associated with needle insertion and withdrawal during lumbar puncture in newborns.

Topics: Anesthetics, Combined; Anesthetics, Local; Chi-Square Distribution; Double-Blind Method; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Lidocaine; Lidocaine, Prilocaine Drug Combination; Lumbar Vertebrae; Pain; Pain Measurement; Prilocaine; Spinal Puncture; Statistics, Nonparametric; Treatment Outcome

Topical lidocaine-prilocaine (EMLA) effectively decreases the pain associated with minor procedures including immunization, although the effect on the antibody response to diphtheria-tetanus-acellular pertussis-inactivated poliovirus-Haemophilus influenzae type b conjugate (DTaP-IPV-Hib) and hepatitis B vaccines has not been assessed.. To measure the antibody response to DTaP-IPV-Hib and hepatitis B vaccines; to measure pain reduction associated with the use of the lidocaine-prilocaine (EMLA) patch; and to assess safety by comparing adverse reactions.. One hundred nine healthy 6-month-old infants (Part A of study) and 56 healthy infants birth to 2 months of age (Part B of study) undergoing primary immunization with DTaP-IPV-Hib and hepatitis B vaccines in an ambulatory setting.. Two center, randomized, double blind, controlled trial of EMLA patch or placebo before DTaP-IPV-Hib and hepatitis B immunization. Antibody titers measured at 0 to 2, 6 and 7 months.. The primary outcome measure was the antibody response to diphtheria, tetanus, pertussis antigens, Haemophilus influenzae type b and hepatitis B by enzyme immunoassay; and poliovirus 1, 2 and 3 by neutralization. The secondary outcomes were pain scores by the Modified Behavioral Pain Scale and drug- and vaccine-associated adverse events collected with a parent diary and structured questionnaire.. There was no difference in the antibody response between the EMLA- and placebo-treated groups as assessed by geometric mean antibody titers, rates of seroconversion or the proportion of participants achieving protective or positive antibody titers postimmunization. At the 6-month visit, EMLA recipients had less pain after immunization (total pain score, 6.75 vs. 7.35; P = 0.005; pain score increase, 3.99 vs. 4.74; P = 0.004) than did placebo recipients. Skin pallor and erythema at the patch application site were more frequently reported after EMLA use. Rates of vaccine-associated adverse events were similar in the two groups.. The EMLA patch has no adverse effect on the antibody response to the vaccine antigens, is effective in reducing pain associated with DTaP-IPV-Hib and hepatitis B immunizations and does not result in any significant or unexpected adverse reactions.

Topics: Administration, Topical; Anesthetics, Local; Antibody Formation; Diphtheria-Tetanus-acellular Pertussis Vaccines; Double-Blind Method; Female; Haemophilus Vaccines; Hepatitis B Vaccines; Humans; Infant; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Poliovirus Vaccine, Inactivated; Prilocaine

Children view needle sticks as the worst source of pain and fear in the hospital setting. In an effort to minimize the pain of needle sticks, the use of eutectic mixture of lidocaine and prilocaine (EMLA) has become standard practice in many children's hospitals. Unfortunately, EMLA requires at least 60 minutes to be fully effective and reportedly may cause vasoconstriction, leading to difficult vein cannulation. A newly available local anesthetic (ELA-Max) may require less time and cause less vasoconstriction. The purpose of this randomized crossover study was to investigate the anesthetic equivalence of EMLA and ELA-Max.. Thirty well children (14 girls and 16 boys) who were between the ages of 7 and 13 years volunteered to have EMLA applied to the dorsal aspect of 1 hand for 60 minutes and ELA-Max applied to the other hand for 30 minutes. Right and left hands were randomized to treatment type and order of intravenous (IV) insertion. Clinical Research Center nurses, blind to the anesthetic randomization, attempted to insert a 22-gauge Teflon IV catheter into a vein in each hand. The children rated pain during IV insertion on the Oucher scale, and the nurse rated the difficulty of the insertion.. There was no significant difference in pain ratings for hands that were treated with EMLA (mean: 20.5) or with ELA-Max (mean: 24), and there was no difference for the difficulty of vein cannulation. Children's preprocedure state anxiety was positively associated with pain ratings.. ELA-Max, applied for 30 minutes before IV cannulation, has an anesthetic effectiveness similar to EMLA applied for 60 minutes. Some children rated IV insertion pain fairly high for both hands (eg, 60 on a 0- to 100-point scale) despite anesthetic treatment. Preprocedural anxiety may affect the perception and/or rating of pain. There were no differences between hands that were treated with EMLA or with ELA-Max for success of IV insertion.

Topics: Adolescent; Age Factors; Anesthetics, Local; Child; Female; Humans; Infusions, Intravenous; Injections, Intravenous; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Pain Measurement; Prilocaine

We conducted a randomized, double blinded, placebo controlled trial to evaluate the effectiveness of EMLA cream together with intraperitoneal lidocaine for pain relief in postpartum tubal ligation. In a factorial designed study, 90 postpartum patients were randomly assigned to have 5 g of EMLA or placebo cream applied to the skin in 2 groups of 45 patients and to have intraperitoneal instillation of 20 ml of either 1 per cent, 2 per cent lidocaine or normal saline in 3 groups of 30 patients. A numerical rating pain score (0-10) was used during skin check, skin infiltration and uterine tube manipulation. The pain scores were significantly lower in the EMLA group as compared with the placebo group during the skin forceps check (p < 0.001) and during local skin infiltration (p < 0.05). The pain scores were also significantly lower during intraabdominal manipulation in the group using either 1 per cent or 2 per cent intraperitoneal lidocaine as compared with the group using normal saline (p < 0.001), but no difference was found between the groups using 1 per cent and 2 per cent lidocaine.. Five g of EMLA cream applied to the skin together with 20 ml of 1 per cent lidocaine instilled into the abdominal cavity effectively decrease intraoperative pain in patients undergoing postpartum tubal sterilization under local anesthesia.

Topics: Adult; Anesthetics, Local; Chi-Square Distribution; Double-Blind Method; Female; Humans; Injections, Intraperitoneal; Intraoperative Complications; Lidocaine; Lidocaine, Prilocaine Drug Combination; Ointments; Pain; Postpartum Period; Pregnancy; Prilocaine; Statistics, Nonparametric; Sterilization, Tubal; Treatment Outcome

A number of studies have shown that orally administered sweet-tasting solutions reduce signs of pain during painful procedures. The local anesthetic cream EMLA has recently been shown to be safe for use in neonates. This study compared the pain-reducing effect of orally administered glucose with that of EMLA cream during venipuncture in newborns.. Randomized, controlled, double-blind study including 201 newborns undergoing venipuncture for clinical purposes. Ninety-nine of the newborns received EMLA on the skin and orally administered placebo (sterile water), and 102 received glucose 30% orally and placebo (Unguentum Merck) on the skin. Symptoms associated with pain at venipuncture were measured with the Premature Infant Pain Profile (PIPP) scale (also validated for full-term infants). Heart rate and crying time were recorded.. There were no differences in background variables between the 2 groups. The results shows that the PIPP scores were significantly lower in the glucose group (mean: 4.6) compared with the EMLA group (mean: 5.7). The duration of crying in the first 3 minutes was significantly lower in the glucose group (median: 1 second) than in the EMLA group (median: 18 seconds). There were significantly fewer patients in the glucose group who were scored having pain (defined as PIPP score above 6); 19.3% compared with 41.7% in the EMLA group. The changes in heart rate were similar in both groups.. We found that glucose is effective in reducing symptoms associated with pain from venipuncture in newborns and seems to be better than the local anesthetic cream EMLA.

Topics: Administration, Oral; Anesthesia, Local; Double-Blind Method; Glucose; Humans; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Ointments; Pain; Pain Measurement; Phlebotomy; Prilocaine

A variety of topical anesthetic compounds are available for use prior to minimally or moderately painful cutaneous laser procedures. A novel lidocaine/tetracaine-based peel has recently been developed that is applied to the skin as a cream and, once air dried, is removed as a flexible film that may prove useful in providing adequate dermal anesthesia for dermatologic laser surgery.. To evaluate the clinical efficacy of a novel topical anesthetic peel preparation for induction of local anesthesia prior to full-face cutaneous laser resurfacing.. A series of 20 patients undergoing full-face single-pass CO2 laser resurfacing were enrolled in a double-blind institutional review board (IRB)-approved study protocol in which two different topical anesthetic products were compared. A 4 cm x 4 cm area of one cheek was randomized to receive the novel lidocaine/tetracaine-based cream peel (S-Caine) while a 4 cm x 4 cm area on the contralateral side received EMLA cream with occlusion for 30 minutes prior to laser treatment. Patients rated the level of pain experienced during laser treatment on each side using a visual analog scale. Independent assessments of observed discomfort and side effects were recorded. Pain scores were significantly lower using the novel lidocaine/tetracaine-based cream peel formulation compared with the EMLA cream. Side effects associated with application of the anesthetic peel were limited to mild transient erythema and skin blanching.. A novel topical lidocaine/tetracaine-based cream peel provides safe and effective dermal anesthesia for single-pass CO2 laser skin resurfacing.

Topics: Anesthesia, Local; Anesthetics, Local; Dermatologic Surgical Procedures; Double-Blind Method; Drug Combinations; Female; Humans; Laser Therapy; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Prilocaine; Treatment Outcome

Needle penetration and local anesthetic infiltration are painful steps of digital ring block. The objective of this study was to evaluate the efficacy of EMLA cream application prior to digital ring block for surgery for ingrown big toenail.. We conducted a prospective, double-blinded, placebo-controlled, randomized clinical trial with 81 patients (range: 12-75 years, mean +/- SD: 30.3 +/- 17.5 years), who underwent big toenail surgery. Prior to the digital block, EMLA cream (Group E) or a placebo cream (Group P) was applied. A visual analog scale (VAS) and a verbal rating score (VRS) from 1 to 10, 10 being most severe pain, were used for assessment of pain during the skin needle penetration and during the infiltration of the anesthetic product.. Data of the VAS and of the VRS during the two steps, respectively, show no significant difference in pain rating between the two groups. In Group E, the gender of the patients had a significant effect on pain perception. Male patients reported less pain than female patients, both during the needle skin penetration and during the infiltration step (P < 0.005). In Group P, reported pain did not differ by gender in either step of the procedure.. We found no clinical benefit in using EMLA during digital nerve block. Although the digital nerves are not deeply located in the small subcutaneous space of the digit, topical anesthesia may not reach them. Moreover, swelling due to injection of the anesthetic product in this small space may also amplify the sensation of pain.

Topics: Adolescent; Adult; Aged; Anesthetics, Combined; Child; Double-Blind Method; Female; Humans; Injections; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Nails, Ingrown; Nerve Block; Ointments; Pain; Prilocaine; Prospective Studies; Toes

Pain during venipuncture is a major source of concern to children and their caretakers. Iontophoresis is a novel technique that uses an electrical current to facilitate movement of solute ions (lidocaine) across the stratum corneum barrier to provide dermal analgesia. In this study, we compared dermal analgesia provided by lidocaine iontophoresis and eutectic mixture of local anesthetics (EMLA). After informed consent, 26 children, aged 7-16 yr, who required venous cannulation on multiple occasions, were enrolled in this prospective, randomized, crossover study to receive EMLA and iontophoresis on separate occasions. During a third session, each subject received his or her preferred treatment. Pain during venipuncture was assessed by the subject, parent, observer, and technician performing the procedure, by use of a 100-mm visual analog scale. The observer also used the Children's Hospital of Eastern Ontario Pain Scale to rate the subject's pain. Ratings of subject satisfaction were also assessed. There were no significant differences between the two groups in the subject-rated visual analog scale or the Children's Hospital of Eastern Ontario Pain Scale scores. Eleven (50%; 95% confidence interval [CI], 31%-69%) of the 22 subjects who completed both sessions preferred iontophoresis. Five subjects (23%; 95% CI, 10%-44%), including two who did not tolerate treatment with iontophoresis, preferred EMLA, and six (27%; 95% CI, 13%-48%) had no preference for the intervention to provide dermal analgesia. We conclude that lidocaine iontophoresis provides similar pain relief for insertion of IV catheters as EMLA and is a useful noninvasive alternative to establish dermal analgesia for venous cannulation.. Iontophoresis is a technique that uses an electrical current to facilitate movement of solute ions (lidocaine) across the stratum corneum barrier to provide dermal analgesia. Lidocaine iontophoresis provides similar pain relief for insertion of IV catheters as eutectic mixture of local anesthetics and is a useful noninvasive alternative to establish dermal analgesia for venous cannulation.

Topics: Administration, Topical; Adolescent; Anesthetics, Local; Child; Cross-Over Studies; Female; Humans; Injections, Intravenous; Iontophoresis; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Pain Measurement; Prilocaine; Prospective Studies

A double-randomized, blinded crossover trial was performed to assess the efficacy of ELA-Max (4% liposomal lidocaine) as compared with eutectic mixture of local anesthetics (EMLA) for pain relief during pediatric venipuncture procedures. Safety was assessed by evaluation for topical or systemic effects and measurement of serum lidocaine concentrations.. A total of 120 children who were scheduled for repeat venipuncture for non-study-related reasons at 2 sites participated in the study. Patients were doubly randomized to treatment regimen (study medication application time of either 30 or 60 minutes) and to the order of application of the topical anesthetics for each venipuncture. The primary outcome measures were the child's rating of pain immediately after the venipuncture procedures using a 100-mm visual analog scale (VAS) tool and the parent's and blinded research observer's Observed Behavioral Distress scores.. Both ELA-Max and EMLA seemed to alleviate venipuncture pain. There was no clinically or statistically significant difference in the patient VAS scores within the 30-minute or 60-minute treatment groups, and there was no clinical or statistical difference in VAS scores between the 30-minute ELA-Max treatment without occlusion and the 60-minute EMLA treatment with occlusion. There were no clinically or statistically significant differences between treatment with ELA-Max and EMLA in parental or blinded researcher Observed Behavioral Distress scores, the most frequent response at any observation time being "no distress.". This study demonstrates that a 30-minute application of ELA-Max without occlusion is as safe and as effective for ameliorating pain associated with venipuncture as a 60-minute application of the prescription product EMLA requiring occlusion.

Topics: Adolescent; Anesthetics, Combined; Anesthetics, Local; Child; Child, Preschool; Cross-Over Studies; Double-Blind Method; Emulsions; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Liposomes; Male; Pain; Pain Measurement; Phlebotomy; Prilocaine; Treatment Outcome

This prospective randomized controlled double-blind trial was performed to investigate whether glyceryl trinitrate (GTN) ointment, applied ten minutes after the removal of a eutectic mixture of local anaesthetic cream, lignocaine/ prilocaine (EMLA), influences site selection for intravenous cannulation in children. Eighty children aged between five and 15 years, having general surgery as day patients, received EMLA cream on both hands for 90 minutes prior to transfer to the theatre suite. Acting as their own controls, the children received GTN on one hand, and placebo on the other, after removal of the EMLA cream and ten minutes prior to the insertion of an intravenous cannula. The application of GTN or placebo to left or right hand was blinded and randomized. At induction, the hand with the visually best quality veins was selected and cannulated. The primary outcome was selection between the EMLA/GTN hand and EMLA/placebo hand. The selection having been made, the number of attempts at cannulation, ease of insertion and pain scores (VAS) for cannulation were also recorded. The choice of hand was positively influenced by the use of GTN, with the GTN hand chosen in 51 of 72 (70%) children who completed the protocol (P = 0.001). The findings of this study suggest that the application of GTN after EMLA removal may be clinically useful in aiding cannulation in children.

Topics: Administration, Topical; Adolescent; Anesthesia, Local; Catheterization, Peripheral; Child; Child, Preschool; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Nitroglycerin; Ointments; Pain; Pain Measurement; Prilocaine; Probability; Prospective Studies; Reference Values; Surgical Procedures, Operative; Treatment Outcome

To determine whether the application of a eutectic mixture of anesthetic cream (EMLA cream) can decrease the pain of lidocaine injection during vasectomy.. 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.. 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.. EMLA cream significantly decreases the pain associated with lidocaine injections given as local anesthesia for vasectomy.

Topics: Anesthesia, Local; Anesthetics, Local; Double-Blind Method; Humans; Injections; Lanolin; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Pain Measurement; Prilocaine; Prospective Studies; Scrotum; Vasectomy

This multicentre, double-blind, placebo-controlled, parallel-group study assessed the efficacy and safety of using Emla (lignocaine/prilocaine) anaesthetic cream to achieve pain control during sharp debridement of chronic leg ulcers of arterial, venous or arteriovenous aetiology. A total of 101 patients (51 Emla, 50 placebo), aged 29-99 years, who had experienced pain associated with previous debridement were included. Patients with an amide anaesthetic allergy, anaesthetic diabetic ulcers, or ulcers > 50 cm2 were excluded. Debridement was initiated approximately 30 minutes after the application of a thick layer of Emla or placebo cream to an ulcer occluded with a plastic wrap. The patient and investigator assessed the pain associated with debridement on a 100 mm visual analogue scale (VAS). The median patient VAS scores were 18 mm and 53.5 mm in the Emla and placebo groups, respectively (p < 0.0001). The corresponding investigator values in the two groups were 20 mm and 49.5 mm, respectively (p = 0.004). Local reactions were mainly transient and mild, and were observed in roughly the same percentage of placebo and Emla-treated patients. After a 30-minute application Emla cream significantly reduced the pain of debridement compared with the placebo.

Topics: Administration, Cutaneous; Adult; Aged; Aged, 80 and over; Anesthetics, Local; Chronic Disease; Debridement; Double-Blind Method; Female; Humans; Leg Ulcer; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Ointments; Pain; Pain Measurement; Prilocaine; Time Factors; Treatment Outcome

To compare the anesthetic efficacy of EMLA cream (eutectic mixture of local anesthetics) with that of LET solution (lidocaine, epinephrine, tetracaine) for pretreating lacerations prior to lidocaine injection.. This was a randomized, double-blind clinical trial in a convenience sample of 60 patients aged 1 to 59 years with traumatic lacerations. Eligible wounds were uncomplicated, clean lacerations < or = 6 hours old. Finger and toe lacerations were excluded. At the time of initial presentation to triage, patients were randomized to LET or EMLA. A nurse applied the topical anesthetic into the laceration with a 5-mL syringe. A physician assessed the laceration edges for the presence of blanching and adequacy of anesthesia to a 27-gauge needlestick. Supplemental lidocaine was then infiltrated through the wound edges and the pain of infiltration was recorded by the patient (or guardian) on a 100-mm visual analog scale marked "most pain" at the high end. A sample of 44 patients had 90% power to detect a 20-mm difference in injection pain (two-tailed alpha = 0.05).. Sixty patients were randomized to LET (29) or EMLA (31). Median age was 8.5 years; 23% were female. Most lacerations were facial and closed with sutures. There was no difference in baseline characteristics between groups. More wounds treated with LET were anesthetic to a needlestick than wounds treated with EMLA (73% vs 40%, p = 0.01); however, there was no between-group difference in the median pain of lidocaine infiltration (LET-12 mm vs EMLA-13 mm, p = 0.89).. Pretreatment of simple lacerations with LET or EMLA at the time of patient presentation results in similar amounts of pain of subsequent local infiltration of lidocaine

Topics: Adolescent; Adult; Anesthetics, Local; Child; Child, Preschool; Double-Blind Method; Female; Humans; Infant; Lacerations; Lidocaine; Lidocaine, Prilocaine Drug Combination; Linear Energy Transfer; Male; Middle Aged; Ointments; Pain; Pain Measurement; Prilocaine; Treatment Outcome; Wound Healing

Eutectic mixture of local anaesthetics (EMLA) cream is used routinely as a local anaesthetic prior to venepuncture in children. Despite this, however, a significant proportion of children will still be distressed. Cognitive-behavioural interventions, such as distraction by breathing and blowing exercises, have been used and found to be helpful as alternative coping strategies. There is, however, a paucity of data regarding effectiveness. We have evaluated the efficacy of distraction therapy as a coping strategy before and during venepuncture, and in these children evaluated the need for EMLA using a prospective, randomized, double-blind, placebo-controlled clinical trial. Twenty-eight children attending for venepuncture were recruited, median age 6 y (range 4-8 y), and randomly allocated to receive either EMLA or a placebo cream. All were given distraction therapy prior to and during the procedure by a play specialist. Venepuncture was carried out by one investigator. A modified paediatric pain assessment chart was used for objective pain score at the end of the procedure. After one exclusion, the treatment group (17 children) and the placebo group (10 children) were similar: median age of 6 and 7 y (range 4-8), median baseline and post-procedure heart rate and oxygen saturation. The median (interquartile range) for total pain score in the treatment group was 1 (0 to 4.5) and in the control group 1 (0 to 2.3). There was no significant difference in pain score between the two groups (Mann-Whitney test, p = 0.7). The 95% confidence interval for the difference in pain score was -1.0 to +3.0.. The low pain score in both groups suggests the effectiveness of distraction therapy, although factors such as skill of the operator and previous experience of the patient group are of relevance. There was no significant difference in the pain score between the EMLA and placebo groups, suggesting that in this age group if carefully selected children receive distraction during venepuncture EMLA may not be necessary.

Topics: Adolescent; Anesthetics, Local; Child; Child, Preschool; Cognitive Behavioral Therapy; Double-Blind Method; Female; Heart Rate; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Pain Measurement; Phlebotomy; Prilocaine; Prospective Studies

A new non-injection anesthetic, lidocaine/prilocaine gel (Oraqix, AstraZeneca) in a reversible thermosetting system, has been developed to provide local anesthesia for scaling/root planing (SRP). The aim of this study was to determine the anesthetic onset and duration of the gel for SRP in patients with periodontitis.. 30 patients were randomized to either 30 s, 2 min, or 5 min of treatment with the gel prior to SRP of a tooth. The gel was applied to periodontal pockets with a blunt applicator. On completion of the SRP of each tooth (2-3 teeth treated/patient), the patients rated their pain on a 100-mm visual analogue scale (VAS).. The median VAS pain score was 7.5 mm in the 30-s group, 28.5 mm in the 2-min group, and 15.5 mm in the 5-min group, with a significant difference between the 30-s and 2-min groups (p=0.03). In 2 patients in the 5-min group, but none in the other groups, the SRP was interrupted due to pain. The mean duration of anesthesia measured as pain on probing were 18.1, 17.3, and 19.9 min in the 30-s, 2-min, and 5-min groups, respectively. There were no reports of numbness of the tongue, lip, or cheek, neither were there any adverse local reactions in the oral mucosa. The gel was easy to apply and did not interfere with the SRP procedure.. Oraqix provides anesthesia after an application time of 30 s, with a mean duration of action of about 17 to 20 min.

Topics: Administration, Topical; Adolescent; Adult; Anesthetics, Combined; Anesthetics, Local; Dental Scaling; Female; Gels; Humans; Hypesthesia; Lidocaine; Lidocaine, Prilocaine Drug Combination; Lip; Male; Middle Aged; Mouth Mucosa; Pain; Pain Measurement; Periodontal Pocket; Periodontitis; Prilocaine; Root Planing; Statistics as Topic; Taste; Time Factors; Tongue

To compare the effect of topical skin anaesthetic agents on the discomfort and anxiety associated with venous cannulation.. Randomised, double-blind, placebo-controlled, within subject, volunteer trial.. 20 healthy volunteers underwent venous cannulation on three separate occasions having received topical skin application of either 4% amethocaine gel (Ametop), 5% eutectic mixture of lidocaine and prilocaine (EMLA) or E45 cream (placebo). Visual analogue and verbal rating scales were used to assess pain and anxiety associated with the venous cannulation, and anticipated anxiety for future cannulation, under each drug condition.. Subjects were aged 22-53 years (mean 32.8 years). The mean visual analogue scores (VAS) for discomfort were found to be significantly lower (p< 0.001) with Ametop (VAS = 18mm) and EMLA (VAS = 29mm) compared with the control (VAS = 38mm). There was a positive correlation (R2 = 72%, p<0.001) between discomfort and the predicted anxiety if cannulation was to be repeated with the same cream. With the placebo a positive correlation (R2 = 19.8%, p = 0.05) was found between the level of anxiety before cannulation and the level of discomfort recorded.. Ametop and EMLA topical anaesthetic agents produce effective skin analgesia for venous cannulation. The use of topical analgesia can reduce perceived anxiety about future cannulation procedures. This has application in the management of anxious patients undergoing intravenous sedation, suggesting that topical analgesia prior to venous cannulation may significantly aid anxiolysis.

Topics: Administration, Cutaneous; Adult; Analysis of Variance; Anesthesia, Dental; Anesthetics, Combined; Anesthetics, Local; Blood Pressure; Catheterization, Peripheral; Conscious Sedation; Dental Anxiety; Double-Blind Method; Female; Heart Rate; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Linear Models; Male; Manifest Anxiety Scale; Middle Aged; Pain; Pain Measurement; Prilocaine; Tetracaine; Veins

The objective of this study was to explore the relation between the application of a mixture of lidocaine/prilocaine cream (eutectic mixture of local anesthetics [EMLA]) before intravenous cannula insertion and perceived pain in the pediatric patient.. Double-blind placebo-controlled trial.. A general inpatient pediatric ward.. We examined 26 male and 31 female patients between the ages of 4 and 12 years who required intravenous cannula insertion. Intravenous insertion was performed on 57 patients, with 29 patients in the placebo group (mean age, 8.1 years) and 28 in the EMLA group (mean age, 8.0 years).. Application of either EMLA cream or placebo 45 minutes before intravenous cannulation.. Pain was scored by the patients using a 0- to 10-cm visual analogue scale combined with a Faces pain scale as well as visual observation by a nurse. Adverse side effects were recorded in a separate table.. Data collected and the differences between the placebo and treated groups were tested using a Mann-Whitney U test. Those children in the EMLA group (mean pain score, 1.25) experienced less pain than those in the placebo group (mean, 8.39). There was no statistical significance between age, sex, and race.. The authors conclude that a topical preparation of lidocaine/prilocaine significantly reduces children's pain during intravenous cannula insertion when applied to an intact dermal layer of the skin and that this effect occurs within 45 minutes.

Topics: Administration, Cutaneous; Anesthetics, Local; Catheterization, Peripheral; Child; Child, Preschool; Double-Blind Method; Drug Combinations; Female; Humans; Infusions, Intravenous; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Pain Measurement; Prilocaine

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anesthetics, Combined; Anesthetics, Local; Drug Administration Schedule; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Phlebotomy; Prilocaine; Tetracaine

The effectiveness of a eutectic mixture lidocaine-prilocaine topical anaesthetic cream (EMLA) patch compared with a placebo patch in the reduction of pain associated with intramuscular immunization was evaluated. As part of the study, 161 children (aged 4-6-y) undergoing routine diphtheria, pertussis, tetanus and polio (DPTP) immunization in five urban and five rural private office settings were randomly assigned to an EMLA patch (n = 83) or a placebo patch control group (n = 78). Pain measurements included: child's self-report on a Faces Pain Scale; facial action on the Child Facial Coding System; the Children's Hospital of Eastern Ontario Pain Scale and parent and technician ratings on a Visual Analogue Scale. Parents also rated their own and their child's immunization-related anxiety on a Visual Analogue Scale. The EMLA patch group had significantly less pain on all four pain measures compared with the placebo group. Of the children in the placebo group, 43% had clinically significant pain, compared with 17% of children in the EMLA patch group. No severe adverse symptoms occurred as a result of either EMLA or placebo patch application.. The EMLA patch reduced immunization pain in 4 to 6-y-old children during needle injection.

Topics: Anesthetics, Combined; Child; Child, Preschool; Diphtheria-Tetanus-Pertussis Vaccine; Double-Blind Method; Drug Combinations; Humans; Immunization; Injections, Intramuscular; Lidocaine; Lidocaine, Prilocaine Drug Combination; Ointments; Pain; Poliovirus Vaccines; Prilocaine; Statistics, Nonparametric

Medium-depth chemical peels are an effective and popular treatment for actinic damage, fine wrinkles, and pigmentary dyschromias. However, they are also uncomfortable. A previous attempt to study the effectiveness of a topical anesthetic gel in 35% trichloroacetic acid (TCA) peeling found a reduction in discomfort but an increased depth of penetration and delayed healing.. To evaluate both the efficacy of two topical anesthetic agents in medium-depth combination peeling as well as the histologic result from chemical peeling combined with topical anesthesia.. Seventy percent glycolic acid (GA) was applied to the entire face of 10 patients and diluted with water after 2 minutes. This was followed by the sequential application of EMLA cream (lidocaine 2.5% and prilocaine 2.5%), ELA-Max cream (lidocaine 4%), and placebo to selected areas on the face for 30 minutes without occlusion. These agents were then removed and 35% TCA was applied to the entire face. The level of discomfort felt by the patients during the TCA peel was recorded, clinical photographs were taken, and bilateral preauricular biopsies were performed at baseline, 48 hours, and 90 days postoperatively.. Clinically there was a statistically significant decrease in pain felt during the 70% GA-35% TCA peel with topical anesthesia when compared to the control. There was no statistically significant difference in efficacy between EMLA and ELA-Max. There was also no difference in either the clinical or the histopathologic appearance between the medium-depth peel combined with topical anesthesia and the medium-depth peel with control.. Both EMLA and ELA-Max decrease the discomfort felt during medium-depth combination chemical peeling without influencing either the clinical or the histopathologic result.

Topics: Anesthetics, Combined; Anesthetics, Local; Biopsy, Needle; Chemexfoliation; Female; Glycolates; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Prilocaine; Skin; Trichloroacetic Acid

The objectives were to determine whether a eutectic mixture of local anesthetic (EMLA) or placebo cream reduces pain during extracorporeal piezoelectric shock wave lithotripsy (EPSWL), and to determine which of the components of the application (i.e., the occlusive dressing, the cream, or the local anesthetic) contributes to analgesia.. A randomized, double blind, crossover study (part 1) was performed in 12 patients who were scheduled for EPSWL procedures on an ambulatory basis who received the first treatment without any intervention and who had verbal pain scores of 70 or more (on a 0-to- 100 scale). For the next two treatments at 2-week intervals, patients were randomly assigned to receive either 10 g EMLA or 10 g placebo cream and then crossed over to receive the other. The cream and occlusive dressing were left in place and immersed in water throughout the procedure. Verbal numeric pain score was assessed at 5 min after receiving the maximal tolerable intensity of shock wave and at the end of the procedure. The study continued (part 2) in 202 ambulatory patients; 125 men and 77 women, American Society of Anesthesiologists physical status I and II, subjected to EPSWL were randomly allocated into five groups who received (1) nothing on the skin (control), (2) plastic occlusive dressing, (3) placebo cream and plastic occlusive dressing, (4) EMLA cream and plastic occlusive dressing, (5) EMLA cream and plastic occlusive dressing for 60 min to achieve cutaneous anesthesia, which was removed before EPSWL. Pain score was evaluated 10 min into the procedure and at the end of the procedure.. Both parts of the study showed that patients who received either EMLA or placebo cream with dressing throughout the procedure experienced less pain and tolerated higher energy levels compared with the control. Patients who received only pre-EPSWL cutaneous anesthesia of EMLA and who received only the occlusive dressing did not have a reduction in pain score.. EMLA and placebo creams under occlusive dressing reduced pain during EPSWL. The presence of the cream itself as a coupling medium contributed to analgesia. This may be a useful, simple, safe, and economical adjuvant technique to reduce pain during immersion EPSWL.

Topics: Adult; Anesthesia, Local; Anesthetics, Local; Cross-Over Studies; Double-Blind Method; Female; Humans; Kidney Calculi; Lidocaine; Lidocaine, Prilocaine Drug Combination; Lithotripsy; Male; Occlusive Dressings; Ointments; Pain; Pain Measurement; Placebos; Prilocaine

Treatment of ingrowing toenail is commonly performed under local anaesthesia with a digital ring block. Ring block can be associated with significant pain, caused by needle insertion and deposition of the local anaesthetic agent. EMLA, a topical anaesthetic cream, is widely used to alleviate the pain of venepuncture. The aim of this study was to investigate whether the discomfort of digital block could be reduced by prior application of EMLA. Fifty-five patients who were scheduled for ingrowing toenail under local anaesthesia were randomized into two groups. In Group 1 (n = 30), EMLA was applied around the base of the affected hallux for at least 1 h before ring block. In Group 2 (n = 25), a placebo cream was used. In this double-blind study, patients assessed the pain caused by a standardized ring block using 100-mm visual analogue pain score. The mean visual analogue pain score in Group 1 was 28.1 and 50.1 in Group 2 (P < 0.0001). We conclude that EMLA significantly reduces the pain associated with digital ring block.

Topics: Adolescent; Adult; Anesthetics, Local; Double-Blind Method; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Nails, Ingrown; Nerve Block; Pain; Pain Measurement; Prilocaine; Prospective Studies

Arterial puncture is a painful procedure requiring prior local anesthesia. Various products are available for pain relief, among them EMLA anesthetic cream.. To compare pain from simple puncture of the radial artery performed with or without application of EMLA anesthetic cream and after infiltration of mepivacaine.. A prospective, random double-blind study of 153 patients in three groups: group A, 51 patients who were applied 1 g of EMLA cream; group B, 52 patients who were applied 1 g of placebo cream; and group C, 50 patients who received infiltration of 0.2 ml of 1% mepivacaine. Pain was assessed on a 10 cm visual analog scale (0, absence of pain; 10, greatest imaginable pain).. Pain intensity reported by the patients was 2.6 +/- 1.8 in group A, 2.9 +/- 1.8 in group B and 1.6 +/- 1.8 in group C. The results for group C were statistically different from those for groups A and B. The difference between groups A (EMLA) and B (placebo), however, was not statistically significant.. Mepivacaine infiltration is the more effective method for minimizing pain from puncture of the radial artery. EMLA anesthetic cream is not effective against pain caused by this procedure.

Topics: Anesthesia, Local; Anesthetics, Local; Arteries; Blood Specimen Collection; Double-Blind Method; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Ointments; Pain; Prilocaine; Prospective Studies

Pain of circumcision is only partially relieved by single modalities, such as penile nerve block, lidocaine-prilocaine cream, and sucrose pacifiers.. To assess the effectiveness of a combination of interventions on the pain response of infants undergoing circumcision.. Cohort study. Group 1 included infants circumcised using the Mogen clamp and combined analgesics (lidocaine dorsal penile nerve block, lidocaine-prilocaine, acetaminophen, and sugar-coated gauze dipped in grape juice). Group 2 included infants circumcised using the Gomco clamp and lidocaine-prilocaine. Infants were videotaped during circumcision, and pain was assessed using facial activity scores and percentage of time spent crying.. There were 57 infants in group 1 and 29 infants in group 2. Birth characteristics did not differ between groups. Infants in group 1 were older than infants in group 2 (17 days vs 2 days) (P < .001). The mean duration of the procedure was 55 seconds and 577 seconds for infants in group 1 and 2, respectively (P < .001). Facial action scores and percentage of time spent crying were significantly lower during circumcision for infants in group 1 (P < .001). The percentage of time spent crying was 18% and 40% for infants in groups 1 and 2, respectively. No adverse effects were observed in infants in group 1; 1 infant in group 2 had a local skin infection.. Infants circumcised with the Mogen clamp and combined analgesia have substantially less pain than those circumcised with the Gomco clamp and lidocaine-prilocaine cream. Because of the immense pain during circumcision, combined local anesthesia and analgesia using the Mogen clamp should be considered.

Topics: Acetaminophen; Analgesia; Analgesics, Non-Narcotic; Analysis of Variance; Anesthesia, Local; Anesthetics, Combined; Anesthetics, Local; Chi-Square Distribution; Circumcision, Male; Cohort Studies; Humans; Infant, Newborn; Intraoperative Complications; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Pain Measurement; Prilocaine

Patients treated by open carpal tunnel decompression under local anaesthetic experience significant pain with the introduction of local anaesthetic before operation. A prospective double-blind randomized placebo controlled trial was carried out to assess whether this pain could be reduced with the pre-application of a topical lignocaine-prilocaine anaesthetic cream. Nineteen patients undergoing simultaneous bilateral operations were studied. Pain, measured with a visual analogue scale, was significantly reduced on the sides treated with anaesthetic cream. On a four point verbal scale the rating on the placebo side was "moderate" or "severe", compared to "mild" on the anaesthetic cream side. The reduction in pain was greater in women, possibly due to a relatively thinner dermis. There were no adverse effects.

Topics: Anesthetics, Local; Carpal Tunnel Syndrome; Decompression, Surgical; Double-Blind Method; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Pain Measurement; Prilocaine; Prospective Studies

A granulating surface is important for skin grafting and healing of leg ulcers. Mechanical debridement to remove necrotic tissue often must be stopped before completion because of pain.. Our purpose was to assess the effect of EMLA cream on the number of debridements required to obtain a clean ulcer and on pain during debridement and to determine its safety after repeated doses.. In this randomized double-blind, placebo-controlled study, 69 patients with venous leg ulcers received cream before debridement until a clean ulcer was obtained (or a maximum of 15 debridements).. EMLA decreased the median number of debridements required for a clean ulcer (EMLA 11.5, placebo >15; P = .019) and decreased pain by 50% (P = .003). Plasma levels of lidocaine, prilocaine, and their main metabolites were low without any apparent accumulation.. EMLA produces effective pain relief for the debridement of leg ulcers and shortens the time to a clean ulcer.

Topics: Administration, Cutaneous; Aged; Anesthetics, Local; Debridement; Double-Blind Method; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Prilocaine; Time Factors; Treatment Outcome; Varicose Ulcer; Wound Healing

To evaluate the anesthetic efficacy of EMLA cream for alleviating pain associated with puncture and pressure in areas where venous catheters are normally inserted.. We performed a prospective, double blind study in 38 volunteers between 25 and 36 years of age, after obtaining informed consent. A 1.5 g dose of EMLA cream was applied to three sites on each patient: the back of the hand, the antecubital fossa and the side of the neck. Placebo cream with similar characteristics was applied to contralateral sites. Pain was evaluated on a visual analog scale (VAS, 0-10). Tactile sensitivity was assessed on a four-point scale (0 = no sensation; 1 = slight sensation; 2 = moderate, and 3 = strong). An analysis of variance study was performed to compare baseline scores to results over time, and placebo results to EMLA scores for each test site.. The assessment of response to puncture and pressure gradually decreased over time for the sites where EMLA cream was applied, but not for the areas where placebo was applied.. The efficacy of EMLA cream varies demonstrably depending on type of stimulus, site of application and time since application.

Topics: Adult; Anesthetics, Combined; Anesthetics, Local; Double-Blind Method; Elbow; Emulsions; Erythema; Female; Hand; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Neck; Needles; Ointments; Organ Specificity; Pain; Prilocaine; Proprioception; Prospective Studies; Pruritus; Punctures; Time Factors

The analgesic effects of single and repeated applications of a eutectic mixture of local anaesthetics (EMLA) cream on both spontaneous and evoked pains were evaluated in 11 patients with post-herpetic neuralgia (PHN). Detection thresholds, pain thresholds and the responses to suprathreshold mechanical and thermal stimuli were quantitatively determined at baseline, 30 min after the first application and after a series of daily applications over six consecutive days (duration of application: 5 h/day). In the acute situation, EMLA produced an overall anaesthetic effect without significantly reducing spontaneous ongoing pain and mechanical allodynia. Repeated applications significantly reduced paroxysmal pain and both the dynamic and static subtypes of mechanical hyperalgesia. The effects on spontaneous ongoing pain were more variable. They were inversely correlated to the magnitude of the thermal deficit at baseline, and were significant only in patients with dynamic mechano-allodynia. Pathophysiological implications of these results are discussed.

Topics: Aged; Aged, 80 and over; Anesthetics, Combined; Anesthetics, Local; Female; Herpesviridae Infections; Hot Temperature; Humans; Hyperalgesia; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Neuralgia; Pain; Pain Threshold; Prilocaine; Sensation

To demonstrate that parent application of eutectic mixture of local anesthetics (EMLA) results in equal reduction of the pain of intravenous (IV) placement compared with clinician application of EMLA, and to assess potential difficulties with parental application.. A 2 x 2 randomized block design was used, with 41 children divided into two age groups (5-12 years vs 13-18 years) and randomized to one of two experimental groups (parent-applied EMLA vs clinician-applied EMLA).. All children were scheduled to have outpatient gastrointestinal endoscopies with IV sedation. EMLA was placed at least 60 minutes before IV insertion either by the parent or a clinician, depending on the experimental group assignment. Outcome measures were child pain ratings and observed behavioral distress ratings. Parents and children were interviewed to determine parent and child anxiety levels in anticipation of the IV insertion, previous needle stick experience, and previous difficulty coping. Feasibility outcomes included technical difficulty with application of EMLA and appearance of the EMLA cream and occlusive covering.. Pain ratings and behavioral distress ratings in the low to moderate range for all groups and ws and were consistent w previous empiric reports of EMLA outcome. There were no significant differences in pain or distress ratings for either the age or the experimental groups. Parent ratings of their child's previous difficulty coping was related to the level of behavioral distress exhibited before (r =.50), during (r =.32) and after (r =.44) the IV insertion. In addition, children's anxiety ratings about IV insertion seemed to differ among groups (although not statistically significant for post hoc comparisons), with the most anxiety reported by the younger children when clinicians applied the EMLA and by older children when parents applied the EMLA.. Parent application of EMLA appears to be as effective as clinician application in reducing children's pain and distress associated with IV insertion. Permitting parents to apply the EMLA at home can allow children who are having procedures on an outpatient basis to benefit from topical anesthesia without having to arrive early to the clinic or hospital. Additionally, application by parents may result in less anticipatory anxiety for younger children.

Topics: Adolescent; Anesthesia, Local; Anesthetics, Local; Anxiety; Child; Child, Preschool; Female; Humans; Injections, Intravenous; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Pain Measurement; Parents; Prilocaine; Self Administration

Various minimally invasive approaches to reduce pain during extracorporeal shock wave lithotripsy (ESWL) have been described. We compared petroleum jelly (Vaselinet) and ultrasound gel in vitro as a contact medium based on the stone fragmentation rate. The analgesic effect of cutaneous petroleum jelly was tested against eutectic mixture of local anesthesia. We also evaluated the outcome of ESWL in a large group of patients treated with petroleum jelly.. In vitro 3 artificial stones were completely fragmented with a MFL 5000* lithotriptor using petroleum jelly or ultrasound gel as a contact medium. A total of 110 patients (group 1) received petroleum jelly before treatment with the same lithotriptor. After retrospective analysis of group 1 we matched 32 patients (group 2) receiving cutaneous eutectic mixture of local anesthesia. Because of the favorable results with petroleum jelly, we used it in another 148 patients, for a total of 258 patients (group V). Treatment dependent pain was scored using a questionnaire as 1--no, 2--minor, 3--tolerable and 4--intolerable. ESWL without additional analgesics had a pain score of 1 to 3.. In vitro petroleum jelly had a superior fragmentation rate compared to ultrasound gel. Our long-term experience with the lithotriptor indicated that only 30% of patients required no additional analgesics with cutaneous ultrasound gel. In contrast, no additional analgesics were needed in only 38% of group 2 compared to 81.8% of group V. The stone fragmentation rate did not differ statistically between groups.. Cutaneous petroleum jelly offers a noninvasive, highly effective, inexpensive treatment modality with no side effects and significant reduction in pain. This ointment is our contact medium of choice.

Topics: Anesthetics, Local; Emollients; Gels; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Lithotripsy; Middle Aged; Pain; Petrolatum; Prilocaine; Prospective Studies; Retrospective Studies

Retrobulbar block is commonly performed to provide anaesthesia for cataract extraction. This technique can cause significant discomfort. A prospective, randomised, placebo-controlled trial was carried out to investigate the efficacy of a eutectic mixture of local anaesthetics (EMLA) and a 4% amethocaine topical formulation (Ametop) in reducing the pain of retrobulbar injection. Ametop and EMLA proved to be of similar efficacy, both being superior to a placebo in alleviating the discomfort of retrobulbar block. No significant side-effects were observed with the use of either formulation.

Topics: Aged; Aged, 80 and over; Anesthesia, Local; Anesthetics, Local; Cataract Extraction; Female; Humans; Injections; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Prilocaine; Prospective Studies; Tetracaine

Lidocaine-prilocaine cream (EMLA) is currently standard therapy to alleviate procedural pain in children. One of the disadvantages of lidocaine-prilocaine is the need to wait for 60 minutes for adequate skin anesthesia. Amethocaine gel (Ametop) is a new topical anesthetic that requires a shorter application time for skin anesthesia.. To compare the relative efficacy and safety of amethocaine gel and lidocaine-prilocaine cream in children with cancer undergoing Port-a-Cath puncture and to determine which patient factors influence judgments about pain.. Randomized, blinded, crossover study. Each child received either 1 g of amethocaine gel for 30 minutes, preceded by a placebo gel for 30 minutes, or 1 g of lidocaine-prilocaine cream for 60 minutes. Children rated the pain using the faces scale, for which scores ranged from 0 to 5. Parents and attending nurse operators rated pain on a 10-cm visual analog scale.. Thirty-nine children participated. The mean age was 10.2 years (range: 5-16 years), and 69% were male. There were no differences in mean pain assessments between amethocaine and lidocaine-prilocaine as rated by the children (2.0 vs 0.5), parents (2.6 vs 6.4), or nurse operators (2.0 vs 0.9). No serious adverse effects were detected with either preparation. Pain scores assigned by parents and children were not influenced by age, gender, duration of diagnosis, or anesthetic regimen (amethocaine versus lidocaine-prilocaine) in the child. Nurses, however, rated pain higher for younger children, and in males during pretreatment with lidocaine-prilocaine.. Amethocaine achieves similar anesthesia to lidocaine-prilocaine during Port-a-Cath administration in children, with an application time that is half of lidocaine-prilocaine. Pain assessments were not influenced by age, gender, or duration of diagnosis of the child. Nurses may perceive that pain is greater for younger children and in males. lidocaine-prilocaine, amethocaine, pain, children, Port-a-Cath puncture.

Topics: Adolescent; Anesthesia, Local; Anesthetics, Local; Catheterization, Central Venous; Catheters, Indwelling; Child; Child, Preschool; Cross-Over Studies; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Pain Measurement; Prilocaine; Punctures; Single-Blind Method; Tetracaine; Treatment Outcome

Hospitalized preterm infants undergo multiple painful heel lances. A two-phase, randomized, controlled trial was undertaken to determine the safety and efficacy of lidocaine-prilocaine 5% cream (EMLA, Astra Pharmaceuticals, L.P, Westborough, MA) for relieving pain from heel lance. One hundred twenty infants were randomly assigned to receive 0.5 g of EMLA or placebo cream for 30 minutes (Phase 1) or 60 minutes (Phase 2) before a routine heel lance. Efficacy was assessed using the Premature Infant Pain Profile (PIPP). Safety was determined by methemoglobin concentration 8 hours after EMLA application and by clinical signs of methemoglobinemia. No significant differences existed on PIPP scores between EMLA and placebo groups in Phase 1 (p < .480) or Phase 2 (p < .831). No infant had any clinical signs of methemoglobinemia. The mean methemoglobin concentration was 1.19% (.47). Approximately 10% of infants had minor skin reactions, and approximately 20% of EMLA-treated infants had blanching at the application site. The authors conclude that EMLA is safe but not efficacious for relieving pain from heel lance in preterm infants.

Topics: Anesthetics, Combined; Anesthetics, Local; Heel; Humans; Infant, Newborn; Infant, Premature; Lidocaine; Lidocaine, Prilocaine Drug Combination; Methemoglobinemia; Pain; Prilocaine; Punctures

The efficacy of lignocaine-prilocaine cream (EMLA) and amethocaine gel (Ametop) in reducing the pain and distress of venepuncture was compared in a single-blind randomized study of 34 children aged 1-14 y. The influences of age, anxiety and past experience were also investigated. Pain was assessed by the researcher using the Observation Scale of Behavioural Distress, and by the parent, doctor and child (if old enough) using a 10-cm, 100-point Visual Analogue Scale (VAS). Doctors also completed a simple rating scale for difficulty of venepuncture. Compared to older children, infants had significantly more anxious parents and were more distressed when being held still. Anticipatory anxiety correlated with higher pain ratings. No differences in the analgesic effect of the two preparations were found. We conclude that whilst EMLA and Ametop are equally effective at reducing the pain of needle puncture, under some circumstances the use of Ametop may be more advantageous.

Topics: Adolescent; Analgesia; Anesthetics, Combined; Anesthetics, Local; Anxiety; Child; Child, Preschool; Humans; Infant; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Pain Measurement; Phlebotomy; Prilocaine; Single-Blind Method; Tetracaine

We set out to compare a eutectic mixture of local anesthetic cream (lidocaine and prilocaine) to dorsal penile nerve block with lidocaine for anesthesia during circumcision.. In a double-blind study, term newborns were randomized to local anesthetic cream and sodium chloride solution dorsal penile nerve block (n = 31) or to placebo cream and lidocaine dorsal penile nerve block (n = 29). Pain was assessed by determination of heart rate, respiratory rate, and behavioral distress scoring. Group differences were evaluated with repeat-measures analyses of variance.. Distress scores and heart rates were significantly higher in the eutectic mixture group than in the lidocaine group. Respiratory rates were higher in the eutectic mixture group but did not reach statistical significance.. Distress scores and heart rates were significantly higher in infants treated with the anesthetic mixture than in infants treated with lidocaine. Dorsal penile nerve block with lidocaine is a more efficacious means of providing anesthesia for neonatal circumcision than the mixture of local anesthetics.

Topics: Administration, Cutaneous; Anesthetics, Combined; Anesthetics, Local; Circumcision, Male; Double-Blind Method; Heart Rate; Humans; Infant, Newborn; Injections, Subcutaneous; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Nerve Block; Pain; Prilocaine

To minimize injection anxiety and discomfort, the podiatric surgeon can choose from a variety of topical anesthetics. Available modalities include skin refrigerants (also referred to as vapocoolants), needleless injection systems, iontophoresis, and eutectic mixtures of topical anesthetic cream such as EMLA Cream. Many of the vapocoolants contain chlorofluorocarbons, which are known to damage the ozone layer, a stratospheric layer that filters out harmful ultraviolet B radiation. In accordance with the 1992 Montreal Protocol, which banned the manufacture of certain chlorofluorocarbon compounds, many commonly used vapocoolants will no longer be available. Some newly marketed vapocoolants produce extremely cold temperatures, limiting their use. This article discusses the properties of various vapocoolants and other topical anesthetics and compares their effectiveness in patient trials.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia, Local; Anesthetics, Local; Atmosphere; Child; Chlorofluorocarbons; Drug Delivery Systems; Female; Humans; Hypothermia, Induced; Infant; Injections; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Ointments; Ozone; Pain; Podiatry; Prilocaine; Single-Blind Method

To compare the efficacy of the dorsal penile nerve block (DPNB) with a less invasive form of local anesthesia, eutectic mixture of local anesthetic (EMLA) cream, for reduction of pain during neonatal circumcision.. Prospective, blinded, randomized, controlled trial.. Tertiary referral, neonatal intensive care nursery in a university teaching hospital.. Fifty infants >/=341/2 weeks postmenstrual age and stable for discharge at time of circumcision; gestational age at birth 25 to 41 weeks; birth weight 600 to 4390 g; age at study 3 to 105 days. An additional cohort of term newborns (n = 20), who were not randomized, were circumcised without anesthesia.. Administration of either EMLA cream (0.5 g topically 1 hour before circumcision) or 1% lidocaine (0.7-1.0 mL subcutaneously 3 minutes before circumcision).. Primary: Neonatal Infant Pain Scale (NIPS) score; secondary: heart rate, respiratory rate. All outcome measures were assessed by an individual who was blinded to the group assignment and did not perform the circumcision.. NIPS scores were significantly lower in the DPNB infants (2.3 +/- 1.8) compared with the EMLA infants (4.8 +/- 0.7). NIPS scores in patients circumcised without anesthesia indicated severe pain. There was a significantly greater increase in heart rate over the duration of the circumcision in the EMLA group than in the DPNB group (49 vs 9 beats per minute). Adverse effects included small hematomas at the site of injection in DPNB infants (10/23), mild erythema at 1 and/or 24 hours after circumcision in the EMLA infants (3/21), and penile edema noted 5 days after circumcision requiring removal of the circumcision bell in 1 DPNB infant.. DPNB provides better pain reduction during neonatal circumcision than EMLA cream. EMLA cream may provide pain reduction compared with no anesthesia during neonatal circumcision.

Topics: Anesthesia, Local; Anesthetics, Local; Circumcision, Male; Humans; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Nerve Block; Pain; Pain Measurement; Penis; Prilocaine; Prospective Studies; Single-Blind Method

Topics: Adult; Anesthetics, Local; Child; Drug Compounding; Erythropoietin; Female; Humans; Injections, Subcutaneous; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Prilocaine; Recombinant Proteins; Renal Insufficiency

In 54 patients who were to undergo surgery of the upper extremity in plexus block anaesthesia the effect of 5 g EMLA (group E) on tourniquet pain was examined and compared with the effect of a semicircular subcutaneous anaesthesia using 10 ml 0.25% bupivacaine (group B) or 10 ml 1% mepivacaine (group M). Among the patients with satisfactory brachial plexus analgesia allowing for surgery (n = 51), the incidence of tourniquet pain was not significantly different between groups E, M and B. Notably, there was no significant difference in the time of tourniquet application. We conclude that topical application of EMLA is as effective as a semicircular subcutaneous anaesthesia with mepivacaine or bupivacaine in the prevention of tourniquet pain during brachial plexus anaesthesia.

Topics: Adult; Aged; Aged, 80 and over; Anesthetics, Local; Brachial Plexus; Bupivacaine; Female; Forearm; Hand; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Mepivacaine; Middle Aged; Nerve Block; Pain; Prilocaine; Single-Blind Method; Tourniquets

Topics: Anesthetics, Local; Child; Double-Blind Method; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Ointments; Pain; Prilocaine; Vaccination

Pain prevents the effective cleansing of many leg ulcers. Pain relief during debridement has been reported after topical anaesthesia with EMLA cream. The purpose of this study was to assess and compare the pain intensity during debridement after different lengths of application time of EMLA. Fifty-nine patients, stratified for leg ulcer type, were randomised to 10, 20 or 60 minutes treatment with EMLA prior to debridement. The pain was rated by each patient on a 100-mm visual analogue scale (VAS). Pain intensity during debridement decreased significantly with increasing duration of EMLA application (p = 0.001). The median values of the VAS pain scores were 41, 20 and 8 in the 10-, 20- and 60- minute groups respectively. A minimum of 20 minutes application time gives substantial pain relief in the majority of patients.

Topics: Administration, Topical; Aged; Aged, 80 and over; Anesthetics, Combined; Debridement; Drug Administration Schedule; Female; Humans; Leg Ulcer; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Pain Measurement; Prilocaine; Time Factors; Treatment Outcome

In a randomized trial, we compared topical anesthesia by a lidocaine-prilocaine cream (EMLA; Laboratorie ASTRA, Manterre, France) with subcutaneous local lidocaine infiltration for radial artery cannulation. Patients included 538 adults scheduled for coronary angiography using a radial approach. EMLA was applied 2 h before radial cannulation, and lidocaine infiltration was performed 5 min before cannulation. The primary end point was pain as assessed by a verbal numerical scale (0 = no pain, 10 = extreme pain). Pain was less severe in the EMLA group than in the lidocaine infiltration group (Score of 2 vs 7; P = 0.0001). Additional lidocaine infiltration was required significantly less frequently in the EMLA group (relative risk 0.19). The failure rate of cannulation was significantly lower in the EMLA group (relative risk 0.38), and insertion time was shorter (4 versus 6 min). We conclude that EMLA, compared with lidocaine infiltration, reduces pain associated with radial artery cannulation and improves the success rate of the procedure. Routine application of EMLA should be performed in awake patients 2 h before radial artery cannulation.. In a randomized trial, we compared topical anesthesia by a lidocaine-prilocaine cream (EMLA) with subcutaneous local lidocaine infiltration for radial artery cannulation in 538 adults patients. EMLA reduced pain associated with radial artery cannulation and improved the success rate of the procedure.

Topics: Adult; Aged; Anesthesia, Local; Anesthetics, Local; Catheterization, Peripheral; Female; Humans; Injections, Subcutaneous; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Ointments; Pain; Pain Management; Prilocaine; Radial Artery

A recent study has shown venepuncture to be more effective and less painful than heel-lancing when a single blood test is performed in neonates [Larsson, Pediatrics (in press)]. The aim of the present study was to investigate the value of EMLA applied on the dorsum of the hand when sampling blood in neonates.. This was a controlled randomized and double-blinded study. One hundred and twenty neonates were randomly allocated to two groups, EMLA or placebo. Five hundred milligrams (0.5 ml) of EMLA or placebo was placed on the dorsum of the hand, covered with an occlusive dressing, and left in place for 60 minutes. For venepuncture, a needle measuring 0.9 x 40 mm was used. The two groups were also compared as regards the total time needed to complete the PKU test and the number of skin punctures required. The facial reaction was videotaped and later analysed by two blinded observers using the Neonatal Facial Coding System (NFCS).. No side effects occurred, except for a temporary blanching or redness of the skin, which disappeared within minutes. Nociceptive response: After skin puncture, the NFCS scores were significantly lower in the EMLA group than in the placebo group (median 287 and 374, respectively). After the first skin puncture, a cry was recorded in 35/55 cases (64%) in the EMLA group and in 38/56 cases (68%) in the placebo group, this difference was not significant. The duration of the first cry was significantly shorter in the EMLA than in the placebo group (median 12 and 31 s, respectively).. In comparison with a placebo, EMLA significantly reduces the pain caused by venepuncture on the dorsum of the hand and does not complicate puncture of the vein.

Topics: Anesthetics, Local; Double-Blind Method; Female; Humans; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Observer Variation; Pain; Pain Measurement; Phlebotomy; Prilocaine

The purpose of this study was to compare jet injection to a syringe and needle in terms of the difference in discomfort and pharmacokinetics after the subcutaneous administration of midazolam.. Using a prospective, randomized, double-blinded study design, 14 subjects were administered midazolam on two separate occasions (at least 2 weeks apart). The subjects were randomly distributed into two groups: syringe and needle (saline)/jet injector (midazolam) or syringe and needle (midazolam)/jet injector (saline). The subjects were randomly assigned to receive either EMLA (eutectic mixture of local anesthetics) or a placebo at the injection site for the first administration and the other topical agent on the second visit. Each subject received one subcutaneous injection in the deltoid region per arm per day. Each injection contained the same volume of solution. Subjects completed visual analog scale (VAS) questionnaires assessing the discomfort of the injection. Blood samples were taken at specified intervals over 2 hours for determination of midazolam levels.. The discomfort associated with the injection was less with the Biojector 2000 (Bioject Inc, Portland, OR) although this was not statistically significant. However, persistent discomfort was significantly greater at the needle site. The mean peak plasma level of midazolam was achieved more rapidly with the Biojector 2000 than with the syringe and needle (P < .05). However, the peak plasma level after jet injection or injection with a syringe and needle was not statistically different.. The results of the study show that the Biojector 2000 is a needle-free injection system that can be used for the administration of a premedicant before induction of anesthesia. It has several advantages, including the potential reduction of anxiety associated with the "fear of needles" and occupational injuries.

Topics: Adolescent; Adult; Anesthetics, Local; Double-Blind Method; Equipment Design; Humans; Hypnotics and Sedatives; Injections, Jet; Injections, Subcutaneous; Lidocaine; Lidocaine, Prilocaine Drug Combination; Midazolam; Middle Aged; Needles; Pain; Pain Measurement; Placebos; Preanesthetic Medication; Prilocaine; Prospective Studies; Syringes

A eutectic mixture of local anesthetics (EMLA) in cream form has been used as a topical anesthetic to reduce the pain of procedures penetrating the skin. It is generally applied for 45 to 60 minutes before the painful procedure. The purpose of this study was to determine whether a 20-minute application of EMLA is useful in reducing the pain of routine peripheral intravenous cannulation in the emergency department (ED). A blinded, randomized, placebo-controlled, paired trial compared the pain of intravenous cannulation in both hands of study subjects: one hand was treated with 20-minute EMLA cream and the other hand was treated with 20-minute placebo cream. Forty subjects identified the more painful hand and scored pain measurements of each hand using a 10-cm visual analog scale. These data failed to demonstrate any significant benefit of EMLA compared with placebo. EMLA is not useful for intravenous cannulation when used for 20-minute application times. There may be more effective and less costly ways of reducing the pain of intravenous cannulation that patients would prefer.

Topics: Anesthetics, Combined; Anesthetics, Local; Catheterization, Peripheral; Emergency Service, Hospital; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Pain Measurement; Prilocaine; Time Factors

Most medications are not absorbed topically due to the stratum corneum barrier. While effective as a topical anesthetic, EMLA cream is absorbed slowly, delaying its effects for up to one hour, thereby limiting its usefulness.. To determine whether removal of the cornified layer of the skin by tape stripping (TS) would allow more rapid onset of anesthesia after topical application of EMLA cream prior to IV catheterization (IVC).. This was a prospective, randomized, controlled trial comparing the levels of pain of IVC 15 minutes after topical application of EMLA cream in patients who had TS vs patients who did not. The setting was a suburban university-affiliated ED. A convenience sample of 68 alert adult patients requiring IVC were enrolled. The primary outcomes measured were pain of IVC and pain of TS using a previously validated 100-mm visual analog scale as well as the IVC success rate.. The pain of IVC was less for TS vs control patients [29.7 mm (95% CI=20.4 to 39.0 mm) vs 15.9 mm (95% CI=9.1 to 22.6 mm), p=0.017]. The mean pain of TS was 4.8+/-7.4 mm. The IVC success rate for TS vs control patients was 91% vs 74% (p=0.056). There were no adverse events after TS.. Removal of the cornified layer of the skin resulted in a more rapid anesthetic effect of EMLA cream as evidenced by lower IVC pain scores after TS. The effectiveness of TS for enhanced absorption of other medications should be investigated.

Topics: Adult; Anesthetics, Combined; Anesthetics, Local; Catheterization, Peripheral; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Ointments; Pain; Prilocaine; Skin

To evaluate the efficacy of EMLA (eutectic mixture of local anaesthetic) for the control of pain related to cryotherapy for the treatment of human papilloma virus (HPV) in the outpatient setting.. A randomised, double blind, placebo controlled study.. 40 patients (20 male and 20 female) with external genital HPV involving an area of no greater than 1 cm2.. The Capital Health Sexually Transmitted Disease Clinic, Edmonton, Alberta, Canada.. Patients in whom EMLA was utilised reported significantly lower scores than those in the control group. Women reported pain scores of 4.7/10 and 0.9/10 in placebo and EMLA groups respectively (p < 0.01). Men reported pain scores of 6.4/10 and 3.1/10 in placebo and EMLA groups respectively (p < 0.01). Men reported significantly higher pain scores than women in the EMLA groups (p < 0.01). There was no significant difference in pain scores between men and women in the placebo groups.. EMLA can provide efficacious topical anaesthesia before cryotherapy for the treatment of external genital HPV.

Topics: Adolescent; Adult; Anesthetics, Combined; Anesthetics, Local; Cryotherapy; Double-Blind Method; Female; Herpes Genitalis; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Prilocaine

We have prospectively assessed pain and anxiety of spinal puncture in 180 adult patients randomly allocated to one of three equal groups. On the morning of surgery group 1 had an EMLA patch, whereas group 2 and 3 had placebo patches. Group 2 also had infiltration analgesia with 2 ml lignocaine 2% with adrenaline, immediately before the block. Spinal anaesthesia was performed with 25 gauge sharp needles without introducer or 25,27 gauge blunt needles with 20,22 gauge introducers. Patients assessed the spinal puncture pain on a 10-cm visual analogue scale immediately after removal of the needle. Pain scores were significantly lower in group 1 (EMLA), median 0.75, than in group 2 (placebo, infiltration analgesia), median 1.75, and group 3 (placebo), median 1.80, p < 0.0001. Pain intensity was less than expected in more patients in the EMLA group than in the other two groups, p = 0.034. However, the decision to accept/reject spinal anaesthesia in the future was not influenced by the pain of lumbar puncture. We conclude that application of an EMLA patch is a simple and effective method to provide adequate analgesia for spinal puncture, which also helps to allay patients' fears of spinal anaesthesia.

Topics: Administration, Cutaneous; Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia, Spinal; Anesthetics, Combined; Anesthetics, Local; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Prilocaine; Prospective Studies; Spinal Puncture

The use of a topical anesthetic cream containing prilocaine and lidocaine (EMLA) has been considered to reduce the pain of diagnostic allergy skin testing, but the effects of the cream on interpretation of skin tests is unclear.. To determine the effects of the cream for pain reduction using prick and ID skin tests and for possible alteration of wheal and flare responses to allergen, saline, and histamine.. In a randomized, double-masked, placebo-controlled design, 20 adult volunteers with a history of positive allergen tests had EMLA and placebo cream placed according to the manufacturer's recommendations on the volar aspect of the arms. Paired skin tests were placed and subjects rated the tests on a pain scale from 0 to 5 and average wheal and flare diameters were determined.. Mean pain scores (+/-SEM) were significantly reduced from 2.5 +/- 0.7 to 1.1 +/- 0.6 for prick tests (n = 20, P < .001) and from 3.2 +/- 0.9 to 1.13 +/- 0.9 for intradermal (ID) tests (n = 58, P < .001). The wheal sizes for allergen prick tests, allergen ID tests, and histamine ID tests were identical in comparing placebo to EMLA-treated skin. Flare responses were reduced on the actively treated skin, on average, as follows: allergen skin tests- 52% (P < .001), and histamine- 40% (P < .001). In nine tests there was complete suppression of the flare response, all on the EMLA treated skin.. EMLA significantly reduced the pain associated with diagnostic allergy skin testing and with no effect on the size of the wheal response. It reduces the flare response, in some cases inhibiting it completely, which must be taken into consideration in interpreting results.

Topics: Adult; Allergens; Anesthetics, Local; Drug Combinations; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Prilocaine; Skin Tests

The efficacy of tetracaine cream versus that of lidocaine-prilocaine cream for the prevention of pain in children undergoing venipuncture was studied. Hospital inpatients 1-15 years of age received, on the back of each hand, a 30-minute application of tetracaine 4% cream or a 60-minute application of lidocaine-prilocaine cream (EMLA, Astra) before undergoing scheduled venipuncture. The phlebotomists in this open, randomized trial evaluated the efficacy of the cream at the moment of venipuncture as adequate, inadequate, or inconclusive. Blood samples were taken immediately after venipuncture from 10 patients one to five years of age to measure the serum concentrations of tetracaine and its metabolite, N-butyl-p-aminobenzoic acid. Lidocaine-prilocaine cream was significantly more efficacious in preventing pain than tetracaine 4% cream (97% of the former group [n = 32] had adequate pain relief, compared with 76% of the latter [n = 34]. The only adverse effects observed were mild local erythema in the tetracaine group and local skin blanching in the lidocaine-prilocaine group. No tetracaine could be detected in serum, and the serum concentrations of N-butyl-p-aminobenzoic acid ranged from 0 to 1.8 mg/l. Statistically, lidocaine-prilocaine cream was more efficacious than tetracaine 4% cream, but the difference is of minor clinical significance and is outweighed by the practical advantages of tetracaine 4% cream, namely the shorter application time, vasodilation and lower cost.

Topics: Administration, Topical; Adolescent; Anesthetics, Local; Child; Child, Preschool; Dosage Forms; Drug Combinations; Female; Humans; Infant; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Phlebotomy; Prilocaine; Tetracaine

Preliminary studies suggested that pain experienced by infants in the neonatal period may have long-lasting effects on future infant behaviour. The objectives of this study were to find out whether neonatal circumcision altered pain response at 4-month or 6-month vaccination compared with the response in uncircumcised infants, and whether pretreatment of circumcision pain with lidocaine-prilocaine cream (Emla) affects the subsequent vaccination response.. We used a prospective cohort design to study 87 infants. The infants formed three groups--uncircumcised infants, and infants who had been randomly assigned Emla or placebo in a previous clinical trial to assess the efficacy of Emla cream as pretreatment for pain in neonatal circumcision. Infants were videotaped during vaccination done at the primary care physician's clinic. Videotapes were scored without knowledge of circumcision or treatment status by a research assistant who had been trained to measure infant facial action, cry duration, and visual analogue scale pain scores.. Birth characteristics and infant characteristics at the time of vaccination, including age and temperament scores, did not differ significantly among groups. Multivariate ANOVA revealed a significant group effect (p < 0.001) in difference (vaccination minus baseline) values for percentage facial action, percentage cry time, and visual analogue scale pain scores. Univariate ANOVAs were significant for all outcome measures (p < 0.05): infants circumcised with placebo had higher difference scores than uncircumcised infants for percentage facial action (136.9 vs 77.5%), percentage cry duration (53.8 vs 24.7%), and visual analogue scale pain scores (5.1 vs 3.1 cm). There was a significant linear trend on all outcome measures, showing increasing pain scores from uncircumcised infants, to those circumcised with Emla, to those circumcised with placebo.. Circumcised infants showed a stronger pain response to subsequent routine vaccination than uncircumcised infants. Among the circumcised group, preoperative treatment with Emla attenuated the pain response to vaccination. We recommend treatment to prevent neonatal circumcision pain.

Topics: Analysis of Variance; Anesthetics, Local; Circumcision, Male; Cohort Studies; Drug Combinations; Humans; Infant; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Pain Measurement; Prilocaine; Prospective Studies; Vaccination

Topics: Anesthetics, Local; Circumcision, Male; Drug Combinations; Humans; Hypnotics and Sedatives; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Pain Measurement; Phlebotomy; Placebos; Prilocaine

We have used EMLA, 4% amethocaine gel and placebo for facial portwine stains, for a period of 1 h, in a double-blind study. After removal of the preparations from the skin surface, each area was treated with six pulses of the laser, each 5 mm in diameter. Any pain noted immediately after treatment was recorded using both visual analogue (VAS) and verbal rating (VRS) scores. Twenty nine patients completed the study and statistical analysis of the results indicated that both EMLA and 4% amethocaine gel were superior to placebo (P < 0.001). However, when EMLA and 4% amethocaine gel were compared, the amethocaine preparation was significantly better (P < 0.05, VAS; P < 0.005 VRS) than EMLA in reducing pain caused by the laser treatment.

Topics: Adolescent; Adult; Anesthesia, Local; Anesthetics, Local; Double-Blind Method; Drug Combinations; Humans; Laser Therapy; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Pain Measurement; Port-Wine Stain; Prilocaine; Tetracaine

The eutectic mixture of local anaesthetics (EMLA) provides effective topical anaesthesia after a minimum of 60 to 90 min application. Since liposome-encapsulated tetracaine (LET) can provide rapid dermal penetration, the goal of this study was to compare the local anaesthetic effects of EMLA and LET in human volunteers after 60 min application.. After obtaining institutional approval and informed consent, healthy volunteers were recruited in a double blind, crossover, randomized trial. The study creams (0.5 ml EMLA and 0.5 ml LET 5%) were applied randomly to opposite arms for 60 min. The discomfort of i.v. catheterization was assessed using a visual analogue pain score (VAS). Cutaneous side effects of the creams were recorded.. Sixty-one subjects were studied. Twenty-one were excluded because of technical difficulties. Forty subjects completed the study and were included in the data analysis. The mean ( +/- SD) VAS was lower for LET than for EMLA (10.9 +/- 9.0 mm vs 22.7 +/- 17.1 mm, P < 0.001). Erythema secondary to vasodilatation occurred more frequent in the LET group than in the EMLA group (33 vs 3, P < 0.001). One subject with a history of atopy developed a rash at the LET application site.. Liposome-encapsulated tetracaine can provide a more effective topical anaesthesia than EMLA for intravenous catheterization after 60 min application. Clinical evaluations are necessary to determine the efficacy and safety of LET in providing topical anaesthesia for various invasive percutaneous procedures in other patient populations.

Topics: Administration, Topical; Adult; Anesthetics, Local; Cross-Over Studies; Double-Blind Method; Drug Carriers; Drug Combinations; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Liposomes; Male; Pain; Pain Measurement; Prilocaine; Tetracaine

Prilocaine-lidocaine emulsion (EMLA) has been used successfully as a local anesthetic in patients undergoing superficial procedures.. The purpose of this study was to investigate the analgesic effect of the patch as a local anesthetic for children undergoing a skin biopsy procedure. The effect on both the pain at the injection site and the pain of the biopsy was investigated.. The study was randomized, double blinded, and placebo controlled. Of the 63 children randomly recruited into the study, 60 children were evaluated; the remaining three were withdrawn from the study.. The anesthetic patch was significantly more effective than the placebo patch in decreasing pain at the injection site. No significant difference in pain scores of the biopsy procedure was found between the study groups. No serious side effects were observed.. The anesthetic patch reduced the pain experienced by children subjected to a skin biopsy procedure.

Topics: Administration, Cutaneous; Adolescent; Anesthetics, Combined; Anesthetics, Local; Biopsy, Needle; Child; Child, Preschool; Double-Blind Method; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Pain Measurement; Premedication; Prilocaine; Skin

Topics: Adult; Anesthetics, Combined; Anesthetics, Local; Biopsy; Ear, External; Elbow; Female; Humans; Knee; Leprosy; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Occlusive Dressings; Pain; Pain Measurement; Prilocaine; Skin

The efficacy of the anesthesia by the Emla cream (a mixture of lydocaine and prylocaine) has been tested on the cervix uteri and the vulva before laser treatment of warts and intraepithelial neoplasia. Five of the six women treated for vulvar warts did not feel any pain during laser treatment after the application of the cream. On the cervix, the pain was evaluated on a median of 9 on a visual scale going from 0 to 100, compared to a median of 25 for women treated without local anesthesia. The efficacy of local anesthesia was best after 4 minutes. The local anesthesia by the Emla cream seems to constitute a real progress in the patient's tolerance of local destructive treatment of cervical and vulvar warts and intraepithelial neoplasia.

Topics: Anesthetics, Combined; Anesthetics, Local; Condylomata Acuminata; Female; Humans; Laser Therapy; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Pain Measurement; Prilocaine; Time Factors; Uterine Cervical Diseases; Uterine Cervical Dysplasia; Vulvar Diseases

Pain relief may be improved by reducing sensitization of nociceptive pathways caused by tissue injury. Such a reduction depends mainly on inhibition of local inflammatory changes and the relation between duration of nociceptive block and nociceptive input. In this study we examined if prolonged topical treatment with local anaesthetics could reduce late hyperalgesia and local inflammation after burn injury in healthy volunteers. The effects of EMLA treatment for 8 h after burn on hyperalgesia, inflammation and wound healing were compared with the contralateral placebo-treated leg for 48 h after bilateral burn injuries (15 x 25 mm, 49 degrees C for 5 min) in a double-blind, randomized study in 12 healthy volunteers. Wound healing was studied 1 and 2 weeks after injury. Neither mechanical nor thermal primary hyperalgesia were affected significantly by prolonged EMLA treatment. Secondary hyperalgesia and skin erythema were also not changed. Seven of 12 placebo-treated legs developed blisters, in contrast with four of 12 EMLA-treated legs. Wound healing showed no apparent differences. Our data suggest that prolonged, topical treatment with local anaesthetics did not reduce local inflammation and late hyperalgesia.

Topics: Adult; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Burns; Double-Blind Method; Drug Combinations; Follow-Up Studies; Humans; Leg; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Ointments; Pain; Prilocaine; Wound Healing

The analgesic effect of topical ibuprofen was investigated in ten volunteers. There were no significant differences in visual analogue scale pain scores for pinprick after 15 and 60 min of application of ibuprofen, placebo and EMLA cream. Comparison of visual analogue scale scores for venous cannulation after similar durations of ibuprofen and EMLA creams found significantly (p < 0.014) lower scores for EMLA at 60 min. We do not consider ibuprofen cream to be clinically useful for venous cannulation.

Topics: Administration, Topical; Analgesia; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Catheterization, Peripheral; Double-Blind Method; Drug Combinations; Humans; Ibuprofen; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Phlebotomy; Prilocaine

The efficacy of EMLA cream combined with glyceryl trinitrate (GTN) ointment was assessed by a double-blind prospective study. Adult female patients were randomly allocated to receive either EMLA 1 ml or 2 ml combined with GTN 2 mg, or EMLA 2 ml only. The difference in pain scores between the three groups was not statistically significant. When GTN was used with EMLA, the quality of the veins was superior and aided intravenous cannulation. There were no significant side-effects. It is concluded that if GTN is used with EMLA, the dose of EMLA can be reduced and intravenous cannulation is technically easier compared with EMLA alone.

Topics: Adult; Anesthetics, Local; Dose-Response Relationship, Drug; Double-Blind Method; Drug Combinations; Drug Therapy, Combination; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Nitroglycerin; Ointments; Pain; Pain Measurement; Phlebotomy; Prilocaine; Prospective Studies

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.

Topics: Adolescent; Ambulatory Care; Anesthetics, Local; Anxiety; Child; Child, Preschool; Double-Blind Method; Drug Combinations; Female; Humans; Infant; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Pain Measurement; Phlebotomy; Prilocaine; Treatment Outcome

This paper describes a model for investigating the efficacy of different methods of alleviating the pain of intra-oral injections. The efficacies of the topical anaesthetic EMLA cream and electronic nerve stimulation as means of reducing the discomfort of palatal injections prior to the extraction of maxillary teeth were investigated using the model in one hundred patients. EMLA reduced the pain of injection compared with placebo (P < 0.05) whereas the pain reported after electronic nerve stimulation did not differ significantly from placebo. It is concluded that EMLA is useful in reducing the pain of palatal injections.

Topics: Administration, Buccal; Adult; Analysis of Variance; Anesthesia, Dental; Anesthetics, Local; Chi-Square Distribution; Drug Combinations; Female; Humans; Injections; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Prilocaine; Transcutaneous Electric Nerve Stimulation

To assess the suitability and effectiveness of EMLA cream (a eutectic mixture of lignocaine and prilocaine) as a topical anaesthetic for routine neonatal circumcision.. A clinical trial of EMLA cream was conducted on 208 consecutive routine neonatal circumcisions. All circumcisions were performed by the Plastibell technique with prior use of EMLA anaesthetic cream. Results were obtained by intra-operative observation and follow-up questionnaire answered by parents.. There was a marked decrease in crying during the procedure. In infants under the age of 7 months, 99.0% fed immediately, 96.0% settled rapidly and remained settled, 96.5% had no disturbance of sleep pattern, 92.5% had little or no pain and 96.0% had no pain or difficulty when urinating. None required stronger analgesia than paracetamol. Infants over the age of 7 months had more difficulty settling; however, their discomfort was no different from that seen in infants of similar age who were circumcised using general anaesthesia. There were no 'serious' complications and only 3.5% had minor complications. There were no side effects or complications attributable to the EMLA cream.. EMLA anaesthetic cream, properly applied, is a safe and effective method of anaesthesia for circumcision of neonates to 7 months of age. It reduces or eliminates pain, restlessness, agitation and interference with parent bonding. The common practice (in Australia) of suggesting that parents postpone circumcision until the child is suitable for general anaesthesia should be seriously questioned.

Topics: Administration, Topical; Age Factors; Anesthetics, Local; Australia; Child, Preschool; Circumcision, Male; Humans; Infant; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Pain Measurement; Prilocaine

We have evaluated the efficacy and safety of a preparation of 4% amethocaine gel in alleviating the pain of venous cannulation in children. In an initial open study of 148 children, clinically acceptable anaesthesia was achieved in 92% of cases. The preparation was then compared with 5% EMLA cream in a single-blind study in 94 patients using an application time of 40 min. We found clinically acceptable conditions in 85% of patients receiving amethocaine gel compared with 66% in the EMLA group. There were no significant adverse effects noted in each group, although 37% of those children treated with amethocaine gel showed localized erythema at the application site. The results suggest that amethocaine gel has greater efficacy and a faster onset time than EMLA cream when used for this purpose in children.

Topics: Administration, Cutaneous; Anesthetics, Local; Catheterization, Peripheral; Child; Child, Preschool; Drug Combinations; Erythema; Female; Gels; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Prilocaine; Single-Blind Method; Tetracaine

The efficacy of a eutectic mixture of local anesthetics (EMLA) in alleviating the pain associated with subcutaneous needle insertion for infusion of the iron-chelating agent, deferoxamine, was examined in 12 patients with homozygous beta-thalassemia. As reported by the patient using a 100-mm visual analogue scale, the pain of insertion was rated as significantly less after application of EMLA (mean +/- SD, 1.5 +/- 2.2 mm) than the pain associated with needle insertion without EMLA (34.8 +/- 33.5 mm, P = .005). Subsequently, in a double-blind randomized trial of 10 beta-thalassemia patients, EMLA was significantly better (5.7 +/- 8.2 mm) than placebo (27.0 +/- 22.8 mm, P = .01) in reducing the pain of needle insertion for deferoxamine infusion. No adverse effects were reported with the use of EMLA cream. These results suggest that EMLA may be effective in reducing the pain associated with needle insertion for subcutaneous deferoxamine infusion in beta-thalassemia patients, which may lead to improved compliance with this irritating, prolonged therapy. The safety of EMLA use in these patients, and others receiving regular parenteral therapy, should now be examined.

Topics: Anesthetics, Local; beta-Thalassemia; Deferoxamine; Double-Blind Method; Drug Combinations; Female; Humans; Injections, Subcutaneous; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Pain Measurement; Pilot Projects; Prilocaine; Time Factors

Three commonly available local anaesthetics were compared, in a controlled trial, for use before venous cannulation. The pain of application of the local anaesthetic, the pain of cannulation, and the rate of successful cannulations were compared. The value of EMLA cream applied for 5 min was questioned. Venous cannulation with a 20G venflon was found to be significantly more painful than the application of any of the local anaesthetics (P < 0.01). Lignocaine 1%, injected subcutaneously, and ethyl chloride spray significantly reduced the pain of venous cannulation (P < 0.01). The use of lignocaine did not result in significantly more failed cannulations than the control group. It was concluded that local anaesthesia should be used before venous cannulation, even for 20G cannulae.

Topics: Adult; Analgesia; Anesthetics, Local; Catheterization, Peripheral; Drug Combinations; Ethyl Chloride; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Ointments; Pain; Prilocaine

To compare the analgesic and anxiolytic effects of nitrous oxide (N2O) when inhaled by face mask with those of a cutaneous application of a eutectic mixture of local anesthetics (EMLA) cream with lidocaine and prilocaine during pre-operative venous cannulation in children.. Prospective, randomized study.. Outpatient presurgical area and operating rooms of a freestanding children's hospital.. 50 unpremedicated ASA status I and II outpatients, aged 6 to 12 years, undergoing an elective surgical procedure.. Each patient received either 70% N2O in 30% oxygen (O2) administered by face mask for 120 seconds or an application of 2.5 g of EMLA cream under an occlusive dressing for a minimum of 60 minutes. All patients then underwent a single attempt at venous cannulation in the dorsum of the hand with a 22-gauge intravenous catheter.. A visual analog scale (VAS) pain score (0 to 100) was generated by the investigator and subsequently obtained from each patient immediately after the venous cannulation was completed. The pain scores generated by the investigator were significantly lower in the N2O group than the EMLA cream group (p = 0.001). When compared with the patients in the EMLA cream group, the patients in the N2O group also self-reported significantly lower VAS pain scores (p = 0.006).. N2O administered by face mask appears to provide greater anxiolysis and attendant superior analgesia for pediatric venous cannulation than a cutaneous application of EMLA cream.

Topics: Administration, Topical; Analgesics, Non-Narcotic; Anesthetics, Local; Anxiety; Catheterization, Peripheral; Child; Drug Combinations; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Nitrous Oxide; Pain; Pain Measurement; Prilocaine

A randomized, placebo-controlled, double-blind study was conducted on 66 healthy patients aged 10-61 years undergoing elective ear, nose and throat surgery to assess the incidence and severity of pain associated with intravenous (i.v.) injection of diluted nalbuphine HCl given during induction of general anaesthesia, and to determine the efficacy of adding lignocaine (2 mg mL-1) to nalbuphine to reduce this pain. Injection of saline produced pain of low intensity in 15% of patients and a withdrawal response in 3% of patients. Injection of nalbuphine mixed with lignocaine produced a significantly higher incidence (36%; P < 0.025) and severity (P < 0.025) of pain than saline, but a similar number of responses (6%) to pain. The diluted nalbuphine alone produced the highest incidence (61%) of pain (P < 0.01 vs. saline, P = NS vs. nalbuphine with lignocaine), which was most severe (P < 0.01 vs. saline, P < 0.025 vs. nalbuphine with lignocaine), and caused the highest number (27%) of withdrawal responses (P < 0.01 vs. saline, P < 0.025 vs. nalbuphine with lignocaine). We conclude that diluted nalbuphine 2 mg mL-1 produces pain on i.v. injection into peripheral veins, and that this can be significantly reduced by adding lignocaine 2 mg mL-1 to the solution.

Topics: Adolescent; Adult; Analgesics, Opioid; Anesthetics, Local; Child; Double-Blind Method; Drug Combinations; Female; Humans; Injections, Intravenous; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Nalbuphine; Pain; Prilocaine

EMLA cream, a lidocaine-prilocaine mixture, penetrates skin easily. Our aim was to compare EMLA and placebo to assess the efficacy of EMLA in decreasing the pain of venipuncture in children premedicated with oral midazolam 0.5 mg/kg.. This was a prospective study enrolling 100 children 3 to 9 years of age (5.6 +/- 2) randomly distributed in 2 groups of 50. EMLA cream was applied in group 1 while placebo was applied in group 2 (control group). All were premedicated with oral midazolam. Either EMLA or placebo was applied at least 30 minutes before transfer to the operating theater and the area was covered with a transparent dressing. Parameters recorded upon arrival in the operating room and upon hand puncture with a 22-G needle were systolic and diastolic arterial pressures (SAP and DAP) and heart rate (HR). Pain was assessed on a behavior scale, a visual analog scale evaluated by the anesthesiologist (VAS-anesthesiologist) and a VAS evaluated by a nurse (VAS-nurse). Adverse events were also recorded. A Student t-test and a Mann-Whitney U-test were used for statistical analysis; the level of significance was p < 0.05.. There were no significant differences in mean age or weight between the 2 groups. In the area EMLA was applied, 2 children presented erythema and 2 pruritus. Mean scores on the pain scales were lower in the EMLA group (p < 0.05) than in the control group: behavior scale 1.8 +/- 1.3 versus 3.2 +/- 1.7; VAS-anesthesiologist 2.8 +/- 2.3 versus 5.1 +/- 2.7; VAS-nurse 2.7 +/- 2.1 versus 5.9 +/- 1.9. HR increased in both groups (with placebo from 105 +/- 16 to 118 +/- 19, and with EMLA from 99 +/- 19 to 109 +/- 21), but the increase in SAP was statistically significant only in the placebo group, in which it rose from 113 +/- 11 to 125 +/- 16.. EMLA cream decreases the pain of hand venipuncture in children premedicated with oral midazolam.

Topics: Adjuvants, Anesthesia; Administration, Oral; Anesthetics, Local; Child; Child, Preschool; Drug Combinations; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Midazolam; Pain; Phlebotomy; Preanesthetic Medication; Prilocaine; Prospective Studies

EMLA cream is an effective local anaesthetic agent for venipunctures in adults and children. The aim of this double-blind, randomised, and placebo-controlled study was to evaluate the effect of EMLA when heel-lancing was performed in neonates. On their third day of life, fullterm healthy infants, who underwent testing for phenylketonuria (PKU) by heel-lancing, were consecutively included in the study. One hundred and twelve neonates were allocated to eight groups according to the application time of EMLA or placebo (10 to 120 minutes). Thus in each group seven infants received active substance and seven placebo. The response to the nociceptive stimulation was assessed by studying the occurrence of a pain cry. No analgesic effect of EMLA was found. There were no adverse effects.

Topics: Anesthetics, Local; Double-Blind Method; Drug Combinations; Female; Heel; Humans; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Prilocaine

Topics: Adolescent; Adult; Anesthesia, General; Anesthetics; Anesthetics, Local; Child; Child, Preschool; Drug Combinations; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Myelography; Nitrous Oxide; Oxygen; Pain; Prilocaine; Spinal Puncture

In an observer blind study, the efficacy of lignocaine-prilocaine eutectic mixture was established in alleviating the pain of needle insertion during retrobulbar and periorbital tissues block in cataract surgery. Thirty-three patients were allocated randomly into two groups. Patients in group 1 (n = 17) received EMLA cream 60 min. prior to local anesthesia while those of group 2 (n = 16) were used as a control group. Pain was graded by the patients on a four-point verbal rating scale (VRS) as well as by an observer, unaware of the treatment patients received, on a 4-point scale. In both groups there were no differences in pain scores between patient's and observer's assessments. In EMLA group significantly (p < 0.05) less pain was registered during performance of the local anesthetic procedure. Our results demonstrate that the eutectic mixture may be very effective in reducing pain associated with locoregional procedures for eye surgery.

Topics: Anesthesia, Local; Anesthetics, Local; Cataract Extraction; Double-Blind Method; Drug Combinations; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Prilocaine

To establish an effective and efficient method of painless venepuncture in children 8 years and older in an ambulatory paediatric surgery centre.. Sixty patients aged 8-21 years were randomized to one of three groups: (i) nitrous oxide with EMLA cream; (ii) nitrous oxide with intradermal lidocaine; and (iii) nitrous oxide alone (n = 20 in each group). Patients in all three groups received oral midazolam for pre-operative anxiolysis. The degree of patient sedation and anxiolysis was noted by two observers before and 2 min after the administration of 50% nitrous oxide. The patient's response to venepuncture or intradermal lidocaine was rated by the two observers using an Observer Response Score. After successful venepuncture, the nitrous oxide was discontinued and the patient was asked to rate the pain of venepuncture using a Patient Response Score.. There were no differences in the degree of sedation and anxiolysis between the three groups before or after the administration of nitrous oxide. Patients in the control group (nitrous oxide alone) had a higher incidence of withdrawal or vocalization with venepuncture. When the patients rated the pain of venepuncture, there were no differences between the three groups.. Oral midazolam in combination with 50% nitrous oxide provides adequate analgesia and anxiolysis for venepuncture in patients 8 years and older. The addition of EMLA cream or intradermal lidocaine will decrease the likelihood of patient movement.

Topics: Adolescent; Adult; Ambulatory Surgical Procedures; Analgesics, Non-Narcotic; Anesthetics, Local; Child; Drug Combinations; Drug Therapy, Combination; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Nitrous Oxide; Pain; Pain Measurement; Phlebotomy; Prilocaine

Recombinant human erythropoietin (rHuEpo) is used to correct anaemia in dialysis patients. Subcutaneous administration of rHuEpo may be associated with pain at the injection site. This study assessed the pain of subcutaneous infiltration of two different preparations of rHuEpo, alpha and beta, and the value of a local anaesthetic (Emla) cream, in reducing the pain of infiltration. Forty-eight haemodialysis patients were enrolled into a double-blind, placebo-controlled, paired-comparison study. Pain was assessed using a visual analogue scale, a verbal descriptive scale and a direct comparison between paired treatments. Subcutaneous injection of rHuEpo alpha was more painful than rHuEpo beta (P < 0.001); using placebo cream 42% of patients described the pain of rHuEpo alpha as severe or very severe, whereas none of the patients found rHuEpo beta so painful. Application of Emla for at least 2 h prior to injection resulted in a significant reduction in the pain of both preparations, but was unable to reduce the pain of rHuEpo alpha to that of rHuEpo beta. Subcutaneous injection of rHuEpo alpha is more painful than rHuEpo beta, even after application of Emla. Although the discomfort of rHuEpo beta is graded as very mild by most adult patients the use of Emla is associated with a significant reduction in discomfort, which may be of benefit to paediatric patients.

Topics: Adult; Aged; Anemia; Anesthetics, Local; Double-Blind Method; Drug Combinations; Erythropoietin; Female; Humans; Injections, Subcutaneous; Kidney Failure, Chronic; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Ointments; Pain; Pain Measurement; Prilocaine; Recombinant Proteins; Renal Dialysis

A prospective, randomised, double-masked, placebo-controlled study was carried out on 169 patients undergoing cataract extraction to compare the topical anaesthetic cream amethocaine with EMLA (eutetic mixture of local anaesthetic, lignocaine and prilocaine) and placebo in reducing pain during retrobulbar injection. Fifty-eight patients received EMLA, 55 amethocaine and 56 the placebo. The pain was assessed objectively by the anaesthetist and subjectively by the patient. Significantly lower pain scores were observed in those patients who had amethocaine (p < 0.001) or EMLA (p < 0.005) in comparison with those who had placebo, but there was no statistical difference between amethocaine and EMLA (p > 0.1; t-test). No systemic or local side-effects were encountered in any group.

Topics: Aged; Aged, 80 and over; Anesthetics, Local; Cataract Extraction; Double-Blind Method; Drug Combinations; Female; Humans; Injections; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Orbit; Pain; Pain Measurement; Prilocaine; Prospective Studies; Tetracaine

Topics: Anesthetics, Local; Child; Drug Combinations; Female; Humans; Injections; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Pain Measurement; Prilocaine

A randomized double-blind study was made of 60 children aged 5 to 11 years to assess the efficacy of a eutectic mixture of local anaesthetics (EMLA), lidocaine and prilocaine, and placebo cream in reducing venepuncture pain. The 5% EMLA or placebo cream, approximately 2 grams (2 ml), was applied to the anticipated venepuncture site and covered with an occlusive dressing for a least 60 minutes. The venepuncture of 20-gauge butterfly needle was done after wiping the skin dry and observing for any local reactions. The pain was evaluated by three methods, one by the investigator and the other two by the children. The results showed that there were no statistical differences in the subject characteristics and pain scores, between the EMLA and the placebo group. Most children in both groups experienced no pain to mild pain from venepuncture. The possible causes were discussed and it was concluded that the placebo effect of having cream and good doctor-children rapport reduced fear and anxiety, resulting in the reduction of venepuncture pain in children.

Topics: Anesthesiology; Anesthetics, Local; Bloodletting; Child; Child, Preschool; Double-Blind Method; Drug Combinations; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Occlusive Dressings; Ointments; Pain; Pain Measurement; Patient Satisfaction; Physician-Patient Relations; Placebo Effect; Placebos; Prilocaine; Time Factors

Almost all dermatologic surgery is accomplished using local anesthesia. To make our patients more comfortable, there is a constant search for less painful methods of administering anesthetic agents. Topical EMLA as well as iontophoresis are both useful in this regard.. In this study we compared topical EMLA with lidocaine delivered by iontophoresis in a double-blind placebo-controlled trial. Our goal was to assess the degree of anesthesia obtained as well as the relative rapidity of onset.. A double-blind controlled study was performed on 10 healthy volunteers between 26 and 37 years of age. Three test sites were placed on each forearm. EMLA or a moisturizer control was placed on two of the three test sites on each arm. Each site was wiped free of cream and tested for sensitivity to pinprick 30 and 60 minutes after cream placement. One iontophoretic unit was placed on each forearm. Both units were saturated with anesthesia with the control unit being turned off. Sensitivity to pinprick was evaluated at the iontophoretic sites and one of the EMLA sites 30 minutes after site placement on the subject. The additional EMLA-treated site was tested in the same manner 60 minutes after placement.. Both EMLA cream and the iontophoretic unit delivered topical anesthesia greater than the control. Significantly more anesthesia was acquired 1 hour after application of EMLA than was seen 30 minutes earlier. The iontophoretic patch-treated area provided greater anesthesia than the EMLA-treated sites evaluated 30 and 60 minutes after placement. Both modalities provided significant anesthesia when left in place for 60 minutes.. Both iontophoresis of lidocaine and topical EMLA delivered significant, and sometimes complete, local anesthesia. A greater degree of anesthesia is delivered via iontophoresis after 30 minutes as compared with EMLA left on the skin for 30 or 60 minutes. Both modalities have important and unique advantages and disadvantages. Topical EMLA and iontophoretically delivered lidocaine are both valuable tools for the dermatologic surgeon.

Topics: Administration, Cutaneous; Adult; Anesthesia, Local; Anesthetics, Local; Double-Blind Method; Drug Combinations; Female; Humans; Iontophoresis; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Placebos; Prilocaine; Sensation; Time Factors; Touch

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.

Topics: Administration, Cutaneous; Adolescent; Adult; Anesthetics, Local; Antineoplastic Agents; Child; Child, Preschool; Double-Blind Method; Drug Combinations; Female; Humans; Injections, Intravenous; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Neoplasms; Ointments; Pain; Prilocaine

We have compared, in a double-blind study, the efficacy of topical amethocaine cream 1 g (5% w/w) in alleviating the pain of venous cannulation with that of 5% EMLA cream 2.5 g. One hundred and twenty unpremedicated female patients undergoing minor gynaecological surgery, were allocated randomly to one of four groups: 5% EMLA cream 2.5 g for 30 min: 5% EMLA cream 2.5 g for 60 min; amethocaine cream 1 g (5% w/w) for 30 min; amethocaine cream 1 g (5% w/w) for 60 min. After removal of the cream, venous cannulation was performed with an 18-gauge cannula. Patients assessed the pain experienced using a 100-mm visual analogue score and four-point rank score. In addition, a blinded observer assessed the patient's response to venous cannulation using a four-point rank score. Good analgesia was obtained in all groups and there was no statistically significant difference in pain scores between the groups.

Topics: Adolescent; Adult; Anesthesia, Local; Anesthetics, Local; Catheterization, Peripheral; Double-Blind Method; Drug Combinations; Female; Hand; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Middle Aged; Pain; Pain Measurement; Prilocaine; Tetracaine; Time Factors

Eutectic mixture of local anaesthetics (EMLA) cream with Tegaderm was compared with pre-packaged EMLA patch with regard to analgesic effect, adhesiveness and local reactions during venepuncture in 178 children from three to ten years. One EMLA patch, or half the contents of a 5 g tube of EMLA cream plus Tegaderm was applied to the dorsum of one hand or antecubital fossa for a minimum of 60 min before venepuncture. The subject and observer assessed the degree of pain on a three-point verbal rating scale. The adhesion of the patch vs Tegaderm to the skin and local reactions were recorded. There was no difference between the two groups in pain associated with venepuncture; 95% of the EMLA patch group and 94% of the EMLA cream group reported no or slight pain. There was no difference between the two treatment groups in terms of overall local reactions. The patch was less adhesive (P < 0.001), but this had no apparent influence on its effectiveness. In conclusion, EMLA patch is equivalent to 5% EMLA cream (2.5 g) in cutaneous pain relief when used for venepuncture in children.

Topics: Adhesiveness; Administration, Cutaneous; Analgesics; Anesthetics, Local; Bloodletting; Child; Child, Preschool; Delayed-Action Preparations; Drug Combinations; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Occlusive Dressings; Ointments; Pain; Pain Measurement; Prilocaine; Skin

Electrolysis and thermolysis are commonly used electrosurgical methods for the permanent destruction of unwanted hair. However, patient fear of pain during treatment may interfere with or even prevent desired treatment of hirsutism on sensitive areas such as the upper lip.. This study was conducted to assess the efficacy of EMLA (Eutetic Mixture of Local Anesthetics), a 5% lidocaine/prilocaine cream, as a topically applied local anesthetic during thermolysis on the upper lip.. A double-blind placebo control study was conducted by the University of Texas Medical Branch thermolysis clinic. Thirty women with idiopathic hirsutism of the upper lip were studied. Pain was measured with a 100 mm visual analog scale (VAS).. Total paired VAS score differences comparing the placebo VAS scores to the EMLA VAS scores were significant by paired t-test (P = .0001). Adverse reactions were mild and transient.. EMLA cream may have multiple applications to the practice of dermatologic surgery, including topically achieved local anesthesia during thermolysis and electrolysis.

Topics: Adolescent; Adult; Aged; Anesthesia, Local; Anesthetics, Local; Double-Blind Method; Drug Combinations; Female; Hair Removal; Hirsutism; Hot Temperature; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Lip Diseases; Middle Aged; Ointments; Pain; Pain Measurement; Placebos; Prilocaine

To determine whether use of lidocaine-prilocaine 5% cream (EMLA) decreases pain associated with diphtheria-pertussis-tetanus (DPT) vaccination in infants.. Randomize, double-blind, controlled trial in outpatient pediatric practice, Toronto, Ontario, Canada. Before vaccination, parents applied 2.5 gm of EMLA or placebo to the infant's leg and covered it with an occlusive dressing for at least 60 minutes. The infant received a 0.5 ml intramuscular injection of DPT at 2 degree to 8 degree C with a 1.6 cm 25-gauge needle; the infant was videotaped. The Modified Behavioral Pain Scale (MBPS) was used to assess baseline and postvaccination pain scores. Latency and duration of infant cry were also measured.. A total of 49 evaluable infants received EMLA, and 47 infants received placebo. There were no significant differences in demographic data; mean age was 5 months; and 50% of the subjects were male. The median difference in pre-vaccination and postvaccination MBPS scores was lower for EMLA than for placebo (p = 0.001). The latency to the first cry was longer for subjects who were treated with EMLA (p = 0.0004)), but the total crying time was shorter (10.3 seconds vs 25.2 seconds; p = 0.027). Of the study group, 90% (45/50) of subjects treated with EMLA and 12% (6/49) of subjects treated with placebo had local skin reactions (p < 0.0001), mainly skin blanching.. Pretreatment with EMLA decreases infant pain from DPT vaccinations. Application of these data is limited to healthy infants receiving DPT vaccinations.

Topics: Anesthetics, Local; Diphtheria-Tetanus-Pertussis Vaccine; Double-Blind Method; Drug Combinations; Female; Humans; Infant; Injections, Intramuscular; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Pain Measurement; Prilocaine; Regression Analysis; Vaccination

To compare the efficacy of a local anesthetic cream and music distraction in reducing or preventing pain from needle puncture (intravenous cannulation) in children. A secondary aim was to examine the influence of age on the pain report and behavior and on the therapeutic outcome.. Children aged 4 to 16 years (N = 180) who were to undergo surgery under general anesthesia via intravenous cannulation were randomly allocated to one of three interventions. The comparison of lidocaine-prilocaine emulsion (EMLA, Astra) and a placebo emulsion was double-blind. Stratification by age group (4 to 6, 7 to 11, 12 to 16) ensured an equal number of children (20) in each intervention/age group category. A global assessment of the behavioral reaction to the procedure was made by the principal investigator, taking into account vocal, verbal, facial, and motor responses. The child was asked to assess pain severity on the Faces Pain Scale (FPS) and a visual analogue toy (VAT). The scales were applied conservatively as ordinal scales: FPS 0 to 6; VAT 0 to 10.. Children who received lidocaine-prilocaine emulsion reported less pain (mean FPS score = 1.42) compared with placebo emulsion (mean FPS score = 2.58) and with music distraction (mean FPS = 2.62). There was a highly significant therapeutic effect (P < .001) on the self-report and behavioral scores. Younger children, regardless of intervention, reported significantly more pain than the older children (mean FPS scores: 2.85, 2.33, 1.43 for age groups 4 to 6, 7 to 11, and 12 to 16 respectively; P < .001). The superiority of the local anesthetic emulsion was maximal in the youngest age group (4 to 6) almost eliminating pain-related behavior, and multiple regression analysis confirmed significant age and treatment effects and revealed interaction between therapeutic effect and age. Although a trend favoring the active emulsion was evident in the older children (7 to 11, 12 to 16) the differences were not significant. The pain scores were influenced by the type (gauge) of cannula, but this did not affect the conclusion regarding therapeutic and age effects. There was no influence of sex, experience with venipuncture, or whether the child was anxious on arrival in the operating room.. The results show that lidocaine-prilocaine emulsion is highly effective in preventing pain from venipunctures in young children, the group in most need of prevention.

Topics: Adolescent; Age Factors; Anesthetics, Local; Catheterization, Peripheral; Child; Child, Preschool; Double-Blind Method; Drug Combinations; Emulsions; Female; Humans; Injections; Lidocaine; Lidocaine, Prilocaine Drug Combination; Logistic Models; Male; Music; Pain; Pain Measurement; Prilocaine

The hypothesis that the variability of physiological parameters may indicate pain or stress in the neonate was examined. Four parameters (heart rate, respiratory rate, transcutaneous oxygen tension, and carbon dioxide tension) were examined over a 2 minute epoch in response to a heel prick in an attempt to measure stress/pain in 35 preterm newborn infants (26-34 weeks' gestation) half of whom were receiving intensive care. The change in absolute values of these parameters did not discriminate a dummy procedure without prick from the actual procedure containing the prick (paired t test), but the variability of the parameters during an epoch showed significant discrimination. Three procedures were evaluated to reduce this distress using unpaired t test. The use of local anaesthetic cream was not successful. The components of the mixture cause vasoconstriction that would reduce blood flow to the heel and lead to more squeezing which is likely to be painful in the presence of tissue damage. A nurse comforting the infant with tactile and vocal stimulation was slightly helpful but the use of a spring loaded lance was most successful in reducing the distress. The use of spring loaded lances may be more humane for heel pricks.

Topics: Anesthetics, Local; Blood Gas Monitoring, Transcutaneous; Blood Specimen Collection; Carbon Dioxide; Drug Combinations; Heart Rate; Humans; Infant, Newborn; Infant, Premature; Lidocaine; Lidocaine, Prilocaine Drug Combination; Ointments; Pain; Prilocaine; Respiration

The skin application of EMLA cream under a Tegaderm dressing was compared in children with a new combined dressing/local anaesthetic patch--the EMLA patch. The analgesic effect during venepuncture was assessed using a visual analogue scale (patients) and a verbal rating scale (investigator). Skin adhesiveness and incidence of local skin reactions with the two types of application were also studied. The study was designed as an open randomised trial with two parallel groups. Sixty children, aged between 5 and 15 years were evaluated. After a minimum application time of 60 min an intravenous cannula was inserted. There was no difference in analgesia as assessed by the patients or the investigators. Mild discomfort at removal of the occlusive dressing/patch was observed in a few patients, but there was no difference in the adhesiveness of the Tegaderm dressing and the EMLA patch. Only mild local skin reactions (with paleness in the anaesthetised skin area) were observed in both groups. It was concluded that both the EMLA patch and the Tegaderm/EMLA cream dressing provide effective dermal analgesia for venepuncture with a 0.8 mm (outer diameter) cannula. The two types of application were indistinguishable but the ease of application of the patch is a distinct advantage.

Topics: Adolescent; Analgesia; Anesthetics, Local; Bloodletting; Child; Child, Preschool; Drug Combinations; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Prilocaine

The analgesic effects of transdermally applied 10% lignocaine aquagel containing 3% glycyrrhetinic acid monohemiphthalate disodium (as an absorption enhancer) and EMLA cream were compared on the forearms of 34 adult volunteers in a double-blind fashion. The mean pinprick pain scores (graded by noting the number of painful pinpricks out of five) at 30, 60 and 90 min after application and 30 min after removal of the anaesthetics were 3.3 (0.3) (mean SE), 1.2 (0.3), 0.3 (0.1) and 0.3 (0.1) respectively, in the lignocaine gel group. Corresponding scores were 3.5 (0.3), 1.5 (0.3), 0.7 (0.2) and 0.1 (0.1) respectively, in the EMLA group. Insertion of a 26-gauge needle into the treated skin to a depth of 1 mm at 90 min after application was not painful in 91% of the volunteers in the lignocaine gel group and 88% of those in the EMLA group. There was no significant difference in any of the corresponding pain scores between the two groups.

Topics: Administration, Cutaneous; Adult; Anesthesia, Local; Anesthetics, Local; Double-Blind Method; Drug Combinations; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Pain Measurement; Prilocaine; Skin Absorption; Time Factors

EMLA (eutectic mixture of local anesthetics) cream is a topical formulation of a mixture of lidocaine and prilocaine. It has been used to achieve local analgesia after application under an occlusive dressing. We carried out a double-blind randomized controlled clinical trial to assess the effect of 5% EMLA (25 mg/mL of lidocaine and of prilocaine) in reducing the pain caused by infiltration of local anesthetic in eyelid surgery. Pain was assessed by means of a modified visual analogue scale ranging from 0 (no pain) to 10 (excruciating pain) in 25 consecutive patients (average age 65 years) undergoing bilateral eyelid surgery. Clinical significance was defined as a difference in pain scores of 3 or more between EMLA and placebo. The mean pain scores for EMLA and placebo were 3.1 and 4.0 respectively, a nonsignificant difference. The EMLA preparation was found not to be clinically effective in reducing pain caused by infiltration of local anesthetic in eyelid surgery.

Topics: Aged; Anesthetics, Local; Double-Blind Method; Drug Combinations; Eyelid Diseases; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Pain Measurement; Prilocaine

We have examined the effect of EMLA on tourniquet pain and compared it with those of subcutaneous ring anaesthesia (SRA), a double cuff technique and a single cuff (control) during i.v. regional anaesthesia. The durations of analgesia (mean 57.3 (SD 16.6) min) and tolerance (72.3 (13.9) min) to tourniquet inflation in the EMLA group were comparable to those in the SRA group (54.1 (16.2) min and 68.3 (19.0) min), but significantly (P < 0.05) greater than those in the control group (30.0 (10.7) min and 45.6 (14.0) min). The double cuff technique was the most effective method, with 91.5 (14.9) min duration of analgesia. We conclude that EMLA provided a significant analgesic effect on tourniquet pain compared with the control group, but a relatively limited analgesic effect compared with a double cuff technique.

Topics: Adolescent; Adult; Aged; Anesthesia, Conduction; Anesthetics, Local; Drug Combinations; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Prilocaine; Single-Blind Method; Time Factors; Tourniquets

The aim of this study was to evaluate the efficacy of the topical analgesic cream EMLA in alleviating the pains caused by needling in electromyography (EMG). During the course of regular neurophysiology clinics, 34 Caucasian patients of both sexes, aged 21 to 69 yr (mean 38.5 +/- 11.4 SD), scheduled for electromyography, were studied. The EMLA was spread thickly on two EMG sites on each arm: E site, on the lateral dorsal aspect of the forearm and A site, on the thenar eminence. Randomization was pre-established. Whenever EMLA was applied blindly on one of the sites of the arm, the placebo was applied on the homologous site of the other arm. After at least 45 min of application (range 45-145 min, mean = 72.3 +/- 22.2), the needle was inserted into the skin and into the muscle. Then the electromyographist asked the patient to score his degree of pain on a visual analogue scale (VAS 1-10 cm) for each level of insertion. The results showed that on the skin of E site, the pain was less after EMLA than placebo (VAS = 0.75 +/- 1.36 vs 3.10 +/- 1.75, P = 0.0001). The untreated E site (placebo) was less sensitive than the untreated A site (VAS = 3.10 +/- 1.75 vs 6.09 +/- 1.96, P = 0.0001). Muscle insertion on E site was less painful on the EMLA sites than placebo (VAS = 2.83 +/- 2.45 vs 5.73 +/- 2.30, P = 0.0001). The VAS scores for skin and muscle insertion on A site were identical whether EMLA or placebo had been applied.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Cutaneous; Adult; Aged; Anesthetics, Local; Drug Combinations; Elbow; Electrodes; Electromyography; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Muscles; Needles; Pain; Pain Measurement; Placebos; Prilocaine; Sex Factors; Thumb; Time Factors

Topics: Anesthetics, Local; Drug Combinations; Histamine; Humans; Injections, Intradermal; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Prilocaine

This study compared the efficacy of EMLA 5% Cream, Xylocaine 5% (lignocaine 5 per cent) and NUM (benzocaine 15 per cent, amethocaine 1.7 per cent) to a placebo in reducing the pain experience during needle insertion. In a random, double blind study three groups of twenty volunteers each had a paired topical anaesthetic/placebo placed bilaterally in the buccal sulcus of the upper premolar regions for two minutes, followed by the insertion of a standard 27 gauge needle to a depth of 5 mm. Pain experience was measured with visual analogue scales. Results showed that all three agents significantly reduced pain when compared with the placebo--EMLA (p less than 0.002); Xylocaine (p less than 0.05); NUM (p less than 0.005).

Topics: Adult; Anesthetics, Local; Benzocaine; Double-Blind Method; Drug Combinations; Female; Humans; Injections; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Mouth Mucosa; Needles; Pain; Placebos; Prilocaine; Tetracaine

Topics: Administration, Topical; Adult; Anesthetics, Local; Double-Blind Method; Drug Combinations; Female; Humans; Injections, Subcutaneous; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Ointments; Pain; Prilocaine; Prospective Studies

EMLA cream (Astra Pharmaceuticals) which contains lignocaine and prilocaine, is widely used in a thick layer to reduce the pain associated with venepuncture. Application of smaller amounts of cream lowers cost and may reduce side-effects. The efficacy of a thick layer (using 2.0 ml) and a thin layer (using 0.5 ml) of lignocaine-prilocaine cream prior to venepuncture was compared in a randomised study of one hundred children. Pain with venepuncture was assessed using a behavioural rating scale as none, slight, moderate or severe. Children in the thin layer study group experienced slight pain more often than children in the thick layer study group (P less than 0.01). No child in either group experienced moderate or severe pain. It is concluded that a thin layer of lignocaine-prilocaine cream is not as effective as a thick layer in producing the pain-free venepuncture which is desirable in children.

Topics: Administration, Cutaneous; Adolescent; Anesthetics, Local; Bloodletting; Child; Child Behavior; Child, Preschool; Crying; Drug Combinations; Humans; Infant; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Prilocaine; Reflex; Surface Properties; Time Factors

Twenty-one patients were included in a double-blind, placebo-controlled, cross-over study with a eutectic mixture of lidocaine and prilocaine (EMLA). EMLA or placebo was placed on the upper lip for 1 hour; diathermy was then performed for 10 minutes. The pain caused by diathermy was evaluated by the patients and the cosmetologist on a four-point scale. The results of the investigation showed that there was significantly less pain after application of 5 gm of EMLA cream on the upper lip than after application of placebo, assessed both by the patient and by the cosmetologist. Eighteen of 20 patients preferred EMLA (p less than 0.0001). Local reactions were few and mild.

Topics: Adult; Aged; Anesthesia, Local; Anesthetics, Local; Diathermy; Double-Blind Method; Drug Combinations; Female; Hair Removal; Hirsutism; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Lip; Middle Aged; Pain; Placebos; Prilocaine

One hundred and four children aged between 1 and 11 years were studied in a double-blind randomised controlled trial of glyceryl trinitrate ointment versus placebo, when used in addition to standard eutectic mixture of local anaesthetics cream. Each child received glyceryl trinitrate ointment on one hand and placebo on the other, and thus acted as his/her own control. A group of 30 children who received only the eutectic mixture on both hands (60 measurements) was also studied. The choice of site and ease of cannulation was scored. Skin colour and venous dilatation under the eutectic mixture were scored on a visual analogue scale. The addition of topical glyceryl trinitrate ointment to the standard eutectic mixture positively affected venous dilatation (p less than 0.01), choice of cannulation site (p less than 0.001), and ease of cannulation (p less than 0.001) of topical anaesthetic-treated skin.

Topics: Administration, Topical; Anesthetics, Local; Catheterization, Peripheral; Child; Child, Preschool; Double-Blind Method; Drug Combinations; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Nitroglycerin; Pain; Pilot Projects; Prilocaine; Skin; Vasodilation; Veins

A randomised, placebo controlled, double-masked study was undertaken in 115 patients undergoing cataract surgery to assess the efficacy of the anaesthetic cream EMLA (eutetic mixture of local anaesthetic, lignocaine-prilocaine) in alleviating the pain of retrobulbar injection. Sixty three patients received the EMLA cream and 52 the placebo cream. The pain was assessed objectively by the anaesthetist, who observed the reaction of the patient on needle insertion, and subjectively by the patient. Significantly lower pain scores were recorded in patients treated with EMLA cream (anaesthetist's observation: p less than 0.01, patient's assessment: p less than 0.006). No patients experienced serious side effects in either treatment group.

Topics: Aged; Aged, 80 and over; Anesthesia, Local; Anesthetics, Local; Bupivacaine; Cataract Extraction; Double-Blind Method; Drug Combinations; Female; Humans; Injections; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Orbit; Pain; Prilocaine

Topics: Anesthetics, Local; Bloodletting; Child Behavior; Child, Preschool; Double-Blind Method; Drug Combinations; Humans; Infant; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Pain Measurement; Prilocaine

The analgesic effect of EMLA 5% cream for surgical cleansing of leg ulcers was investigated in an open study and in a double-blind comparison with placebo. Eighty patients with ulcers of venous or arterial origin participated. The cream was applied under occlusion and removed before cleansing. Plasma concentrations of lidocaine and prilocaine were assessed. The maximum individual concentrations were 0.8 microgram/ml for lidocaine and 0.08 microgram/ml for prilocaine. Pain was assessed according to a verbal rating scale and on a 100 mm visual analogue scale. The median VAS pain scores for EMLA and placebo were 18.5 and 84 mm (p less than 0.01). There were no severe adverse reactions. The results show that there is a need for pain control in surgical debridement of leg ulcers and that EMLA cream gives satisfactory analgesia for this procedure.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Anesthetics, Local; Debridement; Double-Blind Method; Drug Combinations; Female; Humans; Leg Ulcer; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Pain Measurement; Prilocaine; Random Allocation

A quantitative comparison was made of the effect of infiltration of local analgesics and topical analgesic cream (EMLA) on laser-induced pain and histamine-induced wheal, flare and itch. Wheal and flare were quantified by planimetry and analgesia was quantified by the pricking pain threshold to argon laser stimulation. The intensity of histamine-induced itch was scored on a 4-point scale. Local analgesics had no effect on the wheal area. The flare reaction was abolished by infiltrating lignocaine, and gradually inhibited by increased application times of EMLA. Itch was abolished after local lignocaine infiltration, but not significantly reduced after EMLA cream applied for less than 120 min, although the skin was anaesthetized to laser-induced pain. The reduction of flare area correlated to the level of analgesia, which may therefore reflect the cutaneous responsiveness to neurogenic inflammation. It is suggested that itch and pricking pain are mediated by different populations of nerve fibres, as itch can be evoked even when the sensation of pricking pain is abolished. Surgery, skin prick tests and other traumatic procedures should therefore be performed under local anaesthesia to reduce neurogenic inflammation.

Topics: Administration, Topical; Adult; Anesthetics, Local; Drug Combinations; Emollients; Female; Histamine; Humans; Lasers; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Prilocaine; Sensory Thresholds; Skin

One hundred unpremedicated fit day surgery patients aged between 27 and 68 years were allocated randomly into one of four groups and EMLA, glyceryl trinitrate, EMLA and glyceryl trinitrate or a placebo ointment was applied to the dorsum of a hand. The pain and ease of venepuncture were determined at induction of anaesthesia 60 minutes later. Pain scores were also reassessed 1-2 hours after operation. Lower pain scores and easier venepuncture occurred when EMLA and glyceryl trinitrate ointment was applied to the dorsum of the hand.

Topics: Administration, Cutaneous; Adult; Aged; Anesthesia, Intravenous; Anesthesia, Local; Anesthetics, Local; Double-Blind Method; Drug Combinations; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Nitroglycerin; Pain; Prilocaine; Random Allocation

The aim of the study was to evaluate the effect of a lidocaine-prilocaine cream (EMLA cream, Astra) in relieving pain during arterial cannulation. The study had a random, double-blind, placebo-controlled design and included altogether 90 patients. All the patients were premedicated with an opioid before cannulation. An EMLA application time of 60 minutes was used in 60 patients (30 EMLA/30 placebo) and there was no difference in the pain reaction measured on a visual analogue scale (VAS) or on an observer's verbal scale. The study was extended with a further 30 patients (15 EMLA/15 placebo) with an application time exceeding 90 minutes. Between these groups pain experience measured by VAS did not show any significant difference although the mean value was lower in the EMLA group. Observer ratings showed a significant (p less than 0.01) difference in distribution towards lower ratings in the EMLA group. In conclusion EMLA was found to have a weak, but measurable effect when the application time exceeded 90 minutes but not after 60 minutes.

Topics: Anesthetics, Local; Catheterization, Peripheral; Double-Blind Method; Drug Combinations; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Prilocaine

In a double-blind, double-dummy study, the efficacy of topical 5% EMLA cream was compared with that of lignocaine infiltration in alleviating the pain of arterial cannulation. Forty unpremedicated adults were allocated randomly to four groups to receive EMLA cream alone, EMLA and 0.9% saline infiltration, EMLA and 1% lignocaine infiltration or placebo cream and 1% lignocaine infiltration. Following arterial cannulation, pain was assessed by the patient using a visual analogue score and by an independent observer using a four-category verbal rating score. Significantly lower pain scores were observed in all patients receiving EMLA compared with those receiving placebo cream and lignocaine infiltration by both patient (P less than 0.01) and observer (P less than 0.001) assessments. There were no significant differences between the three EMLA groups.

Topics: Administration, Topical; Adult; Anesthetics, Local; Catheterization; Double-Blind Method; Drug Combinations; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Pain Measurement; Prilocaine; Prognosis

The effectiveness of skin anaesthesia after 5 minutes' topical application of a lignocaine-prilocaine cream was evaluated. One hundred and twenty patients estimated the pain of antecubital venepuncture both on a linear scale and verbally after use of the cream for either 5 or 60 minutes, a placebo cream or no treatment. Reported pain was significantly less after only 5 minutes of the lignocaine-prilocaine cream (p = 0.002). The cream can be used to relieve the pain of all routine injections.

Topics: Administration, Topical; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Anesthetics, Local; Bloodletting; Drug Combinations; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Prilocaine; Time Factors

The local analgesic efficacy of EMLA Cream (a eutectic mixture of lidocaine and prilocaine; Astra Pharmaceuticals, Sweden) in reducing the pain at Venous cannulation was investigated in a randommized blind study in 75 children scheduled for elective surgery. In 25 children placebo cream and in 50 children, EMLA cream was applied at the site of venous cannulation 1 hour prior. EMLA Cream was found to be highly effective (84% patients in contrast to 16% patients in placebo group; P less than 0.005). Local side effects of EMLA Cream were negligible.

Topics: Anesthetics, Local; Anxiety; Catheterization, Peripheral; Child; Child, Preschool; Drug Combinations; Female; Humans; Infant; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Occlusive Dressings; Pain; Premedication; Prilocaine

The effectiveness of EMLA cream in relieving the discomfort associated with percutaneous infiltration of lignocaine was assessed in a double-blind, placebo-controlled study. Patients undergoing minor skin surgery were divided into two groups, according to the number of lesions requiring surgery. The first group had a single lesion and were randomized to apply either EMLA or placebo cream 1 h prior to infiltration, whilst the second group received EMLA to one and placebo to the other of two lesions treated at the same clinic attendance. In neither group was there a clinically useful reduction of discomfort, probably due to inadequate dermal anaesthesia, and we would not, therefore, recommend the routine use of EMLA for this purpose. The most recent evidence suggests that a 2-h application time may give more effective dermal anaesthesia, but this would probably limit its use to occasional problematical cases.

Topics: Administration, Cutaneous; Adolescent; Adult; Aged; Anesthesia, Local; Anesthetics, Local; Double-Blind Method; Drug Combinations; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Placebos; Prilocaine; Random Allocation

The analgesic effect and the occurrence of local reactions after repeated application of a lidocaine/prilocaine cream (EMLA 5%) were investigated in 31 haemodialysis patients. The cream was used for alleviation of cannulation pain prior to the haemodialysis (HD) for a period of 1-1.5 years. In each patient 300 to 312 applications of the cream were made during the period. Local skin reactions were recorded after the cream applications and the analgesic effect was evaluated with double-blind, crossover placebo controls at regular intervals. Seventeen patients completed the study. EMLA gave considerable pain relief and was significantly better than placebo at all effect evaluations but one. The frequency of local reactions was low and not correlated to the number of applications of EMLA. Two patients, however, interrupted their treatment due to local irritation.

Topics: Aged; Anesthetics, Local; Catheterization, Central Venous; Dermatitis, Contact; Double-Blind Method; Drug Combinations; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Prilocaine; Renal Dialysis

We studied the effects of EMLA on tourniquet pain in 10 healthy male volunteers. The tourniquet inflation time which was tolerated was significantly longer with EMLA (46.4 (SEM 3.5) min) compared with placebo (37.5 (2.7) min) (P less than 0.05). Linear analogue pain scores increased in both groups over the study period, but were significantly less in the EMLA group at 40 min (P less than 0.05). We conclude that tourniquet pain has a significant cutaneous component.

Topics: Adult; Anesthesia, Local; Anesthetics, Local; Double-Blind Method; Drug Combinations; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Prilocaine; Randomized Controlled Trials as Topic; Tourniquets

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.

Topics: Adolescent; Anesthetics, Local; Bloodletting; Child; Child, Preschool; Drug Combinations; Female; Humans; Injections, Subcutaneous; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Prilocaine; Punctures; Spinal Puncture

The cold and warmth thresholds to thermode stimulation and the sensory and pain thresholds to argon laser stimulation were determined before and after topical application of EMLA (Eutectic Mixture of Local Anaesthetics) cream. The sensory threshold to argon laser stimulation and warmth threshold to thermode stimulation are both described in terms of warmth or faint heat. The sensory threshold persisted for more than 80 min of EMLA application, whereas the warmth and cold thresholds were detectable after 105 min in half the volunteers. Pain evoked by strong laser pulses was abolished after 80 min of cream application. The analgetic effect of topically applied lidocaine/prilocaine, evaluated by the cutaneous thermal and pain threshold, is compatible with the idea that topical application of EMLA cream blocks free nerve endings rather than the nerve fibres, and induces a sequence of sensory loss which, in some respects, differs from that typically observed after perineural application of local anaesthetics. The effect of topically applied anaesthetics is influenced by a number of thermodynamical, anatomical, and physiological factors in the skin.

Topics: Administration, Cutaneous; Anesthetics, Local; Argon; Cold Temperature; Drug Combinations; Hot Temperature; Humans; Lasers; Lidocaine; Lidocaine, Prilocaine Drug Combination; Nerve Fibers; Pain; Physical Stimulation; Placebos; Prilocaine; Random Allocation; Sensory Receptor Cells; Sensory Thresholds; Skin; Thermoreceptors

A topical anesthetic emulsion consisting of a mixture of lidocaine and prilocaine (EMLA) was used in an attempt to reduce the pain associated with radial artery cannulation. Three groups were compared: (1) EMLA applied at least 90 minutes prior to cannulation (EMLA 90); (2) EMLA applied 60 minutes prior to cannulation (EMLA 60); and (3) lidocaine 2% infiltration performed immediately prior to the procedure (infiltration). Pain was registered using visual analog and verbal ranking scales by both the patient and an independent observer. The EMLA 90 group experienced significantly less pain (P < .001) than either the EMLA 60 or lidocaine infiltration groups. There was no statistically significant difference in pain scores between the EMLA 60 and infiltration groups. Local side-effects of EMLA were negligible.

Topics: Anesthesia, Local; Anesthetics, Local; Catheterization, Peripheral; Female; Humans; Injections, Subcutaneous; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Pain Measurement; Prilocaine; Radial Artery; Time Factors; Treatment Outcome

The use of a local anaesthetic cream (EMLA; Astra) for arteriovenous fistula cannulation was compared to placebo in a double-blind randomised manner in 26 patients undergoing chronic haemodialysis who were currently using injections of lignocaine. The EMLA cream was highly effective compared to placebo (P less than 0.001) on visual analogue and verbal rating scales as well as ease of venepuncture (P less than 0.01). It also gave more pain relief and improved the ease of venepuncture compared to lignocaine injections. Patients expressed a strong preference for the EMLA cream, which has advantages that outweigh the cost and convenience factors.

Topics: Adult; Aged; Anesthetics, Local; Catheters, Indwelling; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Female; Humans; Injections, Intradermal; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Ointments; Pain; Pain Measurement; Prilocaine; Random Allocation; Renal Dialysis

A randomised, placebo-controlled, double-blind study was undertaken in 111 children between the ages of 1 and 5 years to assess the efficacy of EMLA 5% cream in the alleviation of venepuncture pain at intravenous induction of general anaesthesia using 27-gauge needles. Pain assessment was made by an operating department assistant using both verbal rating scale and visual analogue scale methods. Seventy-five children, of whom 24 were premedicated, were treated with EMLA cream and 36 with placebo, 14 of whom were premedicated. Significantly lower pain scores were recorded in the children treated with EMLA cream (verbal rating scale: premedicated p less than 0.05, unpremedicated p less than 0.001; visual analogue scale: premedicated p less than 0.0005, unpremedicated p less than 0.0002). No variation in analgesia was found for application times between 30 and 300 minutes and there were no serious side effects.

Topics: Anesthesia, General; Anesthetics, Local; Child, Preschool; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Humans; Infant; Injections, Intravenous; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Pain Measurement; Prilocaine; Random Allocation

EMLA cream (eutectic mixture of local anaesthetics) was tested in a double-blind clinical trial to examine its effect on the pain of venepuncture at induction of anaesthesia in 40 children (aged 3-13 yrs). Four pain-assessment methods were used and an assessment of the technical ease of venepuncture was made. EMLA was found to reduce significantly the pain and technical difficulty of venepuncture. This study confirms that EMLA is an effective method of reducing the pain and technical difficulty of paediatric venepuncture using 25-gauge needles for induction of anaesthesia in children.

Topics: Anesthesia, Intravenous; Anesthetics, Local; Child; Child, Preschool; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Pain Measurement; Prilocaine; Punctures

The local analgesic efficacy of a cream formulation of lidocaine and prilocaine (EMLA) in reducing pain at venous cannulation was investigated in children scheduled for elective surgery. Forty children participated in a double-blind, randomized comparison between EMLA and inactive placebo cream. Another group of 18 children without any local treatment was studied as an additional control material. Subjective pain scores, expressed with a visual analogue scale, were significantly lower in the EMLA group compared with both the group treated with placebo cream (P less than 0.001) and the open control group (no cream; P less than 0.01). Local pallor and slight oedema were the only side-effects, registered in both cream-treated groups. A preliminary study was also carried out with 10 children (five with EMLA and five without) in order to determine whether catecholamine and vasopressin levels in venous blood are affected by the stress and anxiety associated with venepuncture in children premedicated with oral flunitrazepam. No significant hormone responses were, however, detected. The lidocaine concentrations measured in venous blood taken from the application site of EMLA cream were low, and there were no measurable levels of lidocaine in simultaneous blood samples from the opposite extremity. In our opinion EMLA cream is safe and alleviates effectively the pain associated with venepuncture, and thus deserves a place in the routine premedication of children.

Topics: Administration, Cutaneous; Anesthetics, Local; Anxiety; Catecholamines; Catheterization, Peripheral; Child; Child, Preschool; Double-Blind Method; Drug Combinations; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Pain Measurement; Preanesthetic Medication; Prilocaine; Random Allocation; Vasopressins

The effect of the topical application of a lignocaine-prilocaine cream (EMLA) on the pain of venous cannulation was tested in a double-blind manner. Sixty boys and girls between the ages of 4 and 10 yr who were to undergo surgery participated in the study. No analgesic premedication was given and the venous cannulation was performed during the preparation for general anaesthesia. Pain was assessed by the anaesthetist and the patient using a verbal rating scale and two different pictorial scales. The effect of EMLA in the alleviation of the pain of venous cannulation was considered significantly better than placebo by both anaesthetist (P less than 0.001) and patient (P less than 0.05) (verbal scales). One conventional pictorial scale showed a statistically significant difference (P less than 0.05), but the other, based on facial expressions, did not. Local reactions to the cream were minor and transient in both groups.

Topics: Anesthesia, Local; Attitude to Health; Catheterization; Child; Child, Preschool; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Pain Measurement; Prilocaine; Random Allocation

A new, topical anaesthetic formulation, EMLA 5% cream (Eutectic Mixture of Local Anaesthetics), and placebo have been compared in a randomized double-blind study of 51 children. The objectives were to test if EMLA diminishes pain from venipuncture, to evaluate possible adverse reactions, and to determine if there is any influence upon the ease with which the insertion procedure is carried out. Pain was evaluated using a three-graded verbal rating scale. EMLA relieved pain significantly better than placebo (p less than 0.001), and the procedure was considered to be easier after EMLA treatment. No oedema occurred, but a few cases of local redness and paleness were observed after EMLA treatment. However, these reactions were clinically insignificant. It is concluded that EMLA significantly reduces pain from venipuncture, and side effects are mild and transient.

Topics: Anesthetics, Local; Child; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Prilocaine; Punctures

The efficacy of a topical anaesthetic formulation, EMLA 5% cream (Eutectic Mixture of Local Anaesthetics) in obtunding the pain produced by venepuncture, was determined in a double-blind randomized, cross-over study in 31 adult volunteers. Pain was registered on a 10-cm visual analogue scale. In each subject the mean pain score after treatment with EMLA was compared with that following placebo. Twenty-eight subjects had lower pain scores with EMLA, and in the remaining three subjects EMLA and placebo were equi-effective. Transient skin reactions (blanching, erythema and oedema) were observed with both formulations. These reactions were not found to be aggravated by repeated applications.

Topics: Administration, Topical; Adolescent; Adult; Anesthetics, Local; Double-Blind Method; Drug Combinations; Drug Evaluation; Female; Humans; Injections, Intravenous; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Prilocaine

This study was designed to assess the effect of time on the analgesic effect of a local anaesthetic cream consisting of a mixture of 5% lignocaine and prilocaine. The cream and placebo were compared in a double-blind, randomized study in 114 children aged 4-17 years, with application times of 20 minutes and longer. A regression analysis revealed no difference in analgesic effect between cream and placebo when application times were less than 60 minutes. A cusum test showed that the effect of the cream became evident at about 60 minutes. Local adverse reactions consisted mainly of transient paleness of the skin, which did not constitute any clinical problem.

Topics: Adolescent; Anesthetics, Local; Catheterization; Child; Child, Preschool; Double-Blind Method; Drug Combinations; Drug Evaluation; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Prilocaine; Random Allocation; Time Factors; Veins

A new topical anaesthetic formulation, EMLA, consisting of a eutectic mixture of the two local anaesthetics, prilocaine and lidocaine, was used in an attempt to reduce the pain associated with venous cannulation in children. The formulation of the local anaesthetic cream yields a high concentration (approximately 80%) of active substance compared with previous formulations (approximately 20%). A highly statistically significant difference in the experience of pain due to venous cannulation in favour of EMLA compared with placebo was found in this study (P less than 0.001) in 60 children from 6 to 15 years of age. Stimulus of C fibre endings in the subcutaneous tissue and/or the vascular wall seems to be the mechanism behind the slight to moderate discomfort experienced by about one third of the children treated with EMLA. Local side effects of EMLA were negligible.

Topics: Adolescent; Anesthesia, Local; Catheterization; Child; Double-Blind Method; Drug Combinations; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Prilocaine; Veins

Topics: Anesthetics, Local; Humans; Intubation, Intratracheal; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Pharyngitis; Postoperative Complications

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.. To compare the onset, anesthesia depth, and duration of topical 10% lidocaine and EMLA cream.. 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.. The efficacy of EMLA was superior to 10% lidocaine cream, especially regarding anesthesia onset and duration.

Topics: Anesthesia; Anesthetics, Local; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Ointments; Pain; Pain Measurement; Prilocaine

Computations of placebo effects are essential in randomized controlled trials (RCTs) for separating the specific effects of treatments from unspecific effects associated with the therapeutic intervention. Thus, the identification of placebo responders is important for testing the efficacy of treatments and drugs. The present study uses data from an experimental study on placebo analgesia to suggest a statistical procedure to separate placebo responders from nonresponders and suggests cutoff values for when responses to placebo treatment are large enough to be separated from reported symptom changes in a no-treatment condition. Unsupervised cluster analysis was used to classify responders and nonresponders, and logistic regression implemented in machine learning was used to obtain cutoff values for placebo analgesic responses. The results showed that placebo responders can be statistically separated from nonresponders by cluster analysis and machine learning classification, and this procedure is potentially useful in other fields for the identification of responders to a treatment.

Topics: Adult; Analgesics; Cluster Analysis; Female; Healthy Volunteers; Humans; Lidocaine, Prilocaine Drug Combination; Machine Learning; Male; Pain; Pain Measurement; Placebo Effect; Placebos; Randomized Controlled Trials as Topic; Reference Values; Treatment Outcome; Young Adult

Topical anesthetics are widely applied in order to relieve the discomfort and anxiety caused by needle insertion and other painful superficial interventions at the oral cavity. So far, there are no commercially available effective topical anesthetic formulations for that purpose, and the most of developments are related to hydrophilic and low mucoadhesive forms. Therefore, we have prepared different hybrid nanofilms composed of biopolymer matrices (chitosan, pectin, and chitosan-pectin) blended with nanostructured lipid carriers (NLC) loading the eutectic mixture of 5% lidocaine-prilocaine (LDC-PLC), in order to fulfill this gap in the market. These dual systems were processed as hybrid nanofilms by the solvent/casting method, and its mucoadhesive, structural and mechanical properties were detailed. The most appropriate hybrid nanofilm combined the advantages of both pectin (PCT) and NLC components. The resultant material presented sustained LDC-PLC release profile for more than 8 h; permeation across porcine buccal mucosa almost twice higher than control and non-cytotoxicity against 3T3 and HACAT cell lines. Then, the in vivo efficacy of PCT/NLC formulation was compared to biopolymer film and commercial drug, exhibiting the longest-lasting anesthetic effect (> 7 h), assessed by tail flick test in mice. These pectin-based hybrid nanofilms open perspectives for clinical trials and applications beyond Dentistry.

Topics: 3T3 Cells; Anesthesia, Local; Anesthetics, Local; Animals; Biopolymers; Dentistry; Drug Carriers; HaCaT Cells; Humans; Lidocaine, Prilocaine Drug Combination; Mice; Mouth Mucosa; Nanostructures; Pain; Swine

Topics: Administration, Topical; Anesthetics, Local; Benzalkonium Compounds; Benzocaine; Cetrimonium Compounds; Child; Drug Combinations; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Tetracaine

Potentially painful invasive procedures are often performed for diagnostic or therapeutic purposes in hospitalised paediatric patients. Approaches, such as virtual reality (VR), should be sought in order to minimise pain and anxiety during these procedures.. Hospitalised patients between 4 and 15-years-old requiring an invasive procedure were included. Pain and anxiety evaluation scales were given to children, relatives and health workers. A comparison was made with patients in whom VR was used (with or without concomitant use of a prilocaine/ lidocaine 2.5% analgesic cream) and patients in whom neither VR nor analgesic cream were used.. The study included 58 patients, 38 in the VR group and 20 in the control group. Pain scores, as performed by patients, relatives and health workers, significantly decreased in the VR group (control group median 4/5 vs. VR group median 1/5, P<.001). Patient-reported anxiety scales were also lower in the VR group (control group median 4/5 vs. VR group 1/5, P=.001). The number of punctures (R. The use of VR can reduce pain and anxiety during invasive procedures in hospitalized children.

Topics: Adolescent; Anesthetics, Local; Anxiety; Child; Child, Preschool; Female; Hospitalization; Humans; Lidocaine, Prilocaine Drug Combination; Male; Pain; Pain Management; Pain Measurement; Prospective Studies; Punctures; Virtual Reality Exposure Therapy

Topics: Adolescent; Analgesia; Anesthetics, Local; Child; Child, Preschool; Emergency Service, Hospital; Humans; Infant; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Pain Management; Pain Measurement; Spinal Puncture

Cavitation plays a substantial role in the clinical effects of extracorporeal shock wave therapy (ESWT). It is also generally accepted as a major mechanism in sonophoresis. To identify the enhancing effect of extracorporeal shock wave-mediated transdermal drug delivery, 24 Wistar rats were randomly assigned to four groups: (i) topical application of a eutectic mixture of local anesthetics (EMLA); (ii) 1-MHz ultrasound; (iii) ESWT pre-treatment combined with EMLA application; (iv) ESWT concurrent with EMLA application on rat tails. The degree of anesthesia was assessed using the amplitude and latency of sensory nerve action potentials within 5 min after a 60-min EMLA application. The results indicated that ESWT pre-treatment and concurrent ESWT accelerated the anesthetic effects of the EMLA cream on the tail nerve (p < 0.05). This finding might indicate that shock wave-mediated transdermal drug delivery is possible during the ESWT period.

Topics: Administration, Cutaneous; Anesthetics, Local; Animals; Disease Models, Animal; Extracorporeal Shockwave Therapy; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Prilocaine; Rats; Rats, Wistar; Tail

Pain control, which is necessary during most dental procedures, is administered by injecting a local anaesthetic. Because the injection itself can be painful, the procedure via which pain is reduced warrants continued investigation. Only a few studies regarding the reaction of children to dental needle insertion without the use of topical anaesthetics have been reported. This study was conducted to evaluate the efficacy of the local anaesthetic procedure without topical application as compared to the conventional insertion technique for alleviating pain in children receiving local anaesthesia injections.. For the alternative injection procedure, the dentist quickly and gently pulled or pushed the clean and dried loose tissue at the injection site over the tip of the needle to a depth of 1 to 1.5 mm. When the end of the bevel of the needle tip entered the tissue, a few drops of solution were released, after which the needle was advanced to its proper and intended depth to continue anaesthetic release.. There was a significant difference regarding the pain response between the alternative insertion technique (less painful) and the conventional one according to Sound, Eye, and Motor (SEM) scale ratings (P < 0.000). No significant difference was observed in the response between the maxilla and mandible, nor between boys and girls, between the conventional and alternative techniques.. This alternative technique can reduce discomfort in paediatric dental patients and allow the clinician to administer a superficial local anaesthesia injection before the needle is advanced into deeper tissue. This technique is simple, quick, devoid of additional costs, and potentially more effective than the conventional needle insertion method.

Topics: Anesthesia, Dental; Anesthesia, Local; Anesthetics, Combined; Anesthetics, Local; Child; Child, Preschool; Epinephrine; Female; Humans; Injections; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Needles; Nerve Block; Pain; Pain Measurement; Prilocaine; Vasoconstrictor Agents

The use of creams is considered to be generally safe. However, systemic side effects can occur.. A 22-year-old woman came to the emergency department with dyspnea, confusion and 'blue' skin after laser treatment of the upper legs for excessive hair. She had used three tubes of a eutectic mixture of local anaesthetics (EMLA) cream containing lidocaine/prilocaine for analgesia. Her oxygen saturation was 87%, measured with pulse oximetry. Blood gas analysis showed a concentration of oxy-Hb of 79% and a met-Hb of 19%. Our working diagnosis was methaemoglobinaemia as a result of using excessive amounts of EMLA cream. Because the met-Hb concentration decreased spontaneously and the oxy-Hb concentration consequently normalised, we did not administer methylene blue. The patient was discharged symptom-free after several hours of observation.. An overdose of EMLA cream, whether or not in combination with laser-induced skin damage, can produce a high systemic o-toluidine concentration. This can lead to methaemoglobinaemia. In such cases, the pulse oximeter is not reliable for measuring the oxygen saturation; therefore, blood gas analysis is necessary for making a diagnosis.

Topics: Analgesics; Anesthetics, Combined; Anesthetics, Local; Blood Gas Analysis; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Methemoglobinemia; Pain; Prilocaine; Young Adult

A peripherally inserted central catheter (PICC) is a central venous access mostly used in France in the adult population, whereas it is only rarely used in the pediatric population. The main objective of this study was to analyze a cohort of children treated with PICCs inserted under radiological guidance. We conducted a single-center study in the Radiology department of Nice University Hospital and the Lenval Foundation Children's Hospital. During a 43-month period between November 2008 and June 2012, a total of 67 catheter placement attempts were performed in 57 pediatric patients aged from 7 months to 18 years. We achieved 95.5% technical success with a median procedure duration of 17min. Only 6% of the PICC placements required light intravenous sedation; all the others were performed using a combination of local anesthesia, EMLA cream, and equimolar mixture of oxygen and nitrous oxide (EMONO). Subjective scale analysis of pain during catheter insertion showed a median score of 2.1. Catheter life ranged from 1 to 210 days (median, 38.3 days) with the treatment fully completed in 75% of the cases. The overall complication rate was 18.7% (4.9 per 1000 catheter-days), largely dominated by mechanical complications (9.4%) such as accidental removal (6.2%) or catheter obstruction (3.1%). Infectious complications occurred in 7.8% of the patients. The duration of catheterization and the use of tape to secure the catheter significantly affected the occurrence of complications. Peripheral insertion of central catheters was highly feasible in infants and children. It is a simple, safe, and effective alternative to intravenous central devices in the pediatric population. The occurrence of complications, typically mechanical, must be reduced and prevented by strict management of this type of central line by the nursing team.

Topics: Adolescent; Anesthesia, Local; Anesthetics, Combined; Anesthetics, Local; Catheter-Related Infections; Catheterization, Central Venous; Catheterization, Peripheral; Child; Child, Preschool; Cohort Studies; Conscious Sedation; Female; Humans; Infant; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Pain Measurement; Prilocaine

Quality of life is an important issue in endocrine tumors because of the high prevalence of benign tumors and the indolent course of most malignant tumors.. To evaluate the frequency and the intensity of pain and anxiety in patients undergoing thyroid nodule fine-needle aspiration cytology (FNAC) and to identify factors associated with pain.. Single center prospective study in the setting of a one-stop outpatient diagnostic clinic for thyroid nodules. Pain was evaluated using a 100-mm visual analogue scale (VAS) immediately following (VAS1) and 30 minutes after (VAS2) FNAC and was considered significant if ≥ 30. Anxiety symptoms were assessed prior to FNAC using a self-report measure questionnaire: the state form of Spielberger State-Trait Anxiety Inventory (STAI, form Y-A). FNAC was performed with a 25-gauge needle and a moderate aspiration and two passes for each nodule.. Two hundred eighteen consecutive patients (163 females, 55 males; mean age 53 years, range 12-84 years) undergoing FNAC of one to three nodules were included. VAS1 was ≥ 30 in 24% of the patients and VAS(2) was ≥ 30 in 13% of the patients. Independent significant factors correlated to a VAS1 of ≥ 30 were age under 25 years and the number of nodules being biopsied. Independent significant factors correlated to a VAS2 of ≥ 30 were VAS1 ≥ 30 and female sex. No correlation was found between pain and nodule size or nodule depth, nor the duration of application of the eutectic mixture of local anesthetics (EMLA) patch prior to FNAC. The mean STAI score for anxiety was 37 ± 12. The average STAI score was significantly higher in women (39) than in men (33; p = 0.01). There was no significant correlation between STAI score and age under 25 years, previous FNAC, number of nodules biopsied, or acetaminophen administration, but the STAI score was significantly correlated to VAS1 and VAS2.. FNAC-related pain is frequent and correlates with the number of nodules biopsied, age under 25 years, female sex, and anxiety.

Topics: Acetaminophen; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Ambulatory Care Facilities; Analgesics, Non-Narcotic; Anesthetics, Combined; Anesthetics, Local; Anxiety; Biopsy, Fine-Needle; Child; Female; France; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Pain Measurement; Predictive Value of Tests; Prilocaine; Prospective Studies; Risk Factors; Sex Factors; Surveys and Questionnaires; Thyroid Gland; Thyroid Nodule; Young Adult

Patients living with chronic leg ulceration may frequently experience moderate to severe wound-related pain, which may not be alleviated by oral analgesics alone. Poorly controlled leg ulcer pain can prevent timely and effective wound management strategies being implemented, and increase wound healing times. Furthermore, patients with poorly controlled leg ulcer pain can experience continuous pain, which significantly affects quality of life. This case report introduces an innovative way of using the eutectic mixture of local anaesthetics (EMLA) 5% cream to reduce wound-related pain, reduce oral analgesic intake, and improve health-related quality of life for a patient with a painful, chronic lower leg ulcer.

Topics: Analgesics; Bandages; Drug Therapy, Combination; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Middle Aged; Pain; Prilocaine; Varicose Ulcer; Wound Healing

Ear tattooing is a routine procedure performed on laboratory, commercial and companion rabbits for the purpose of identification. Although this procedure is potentially painful, it is usually performed without the provision of analgesia, so compromising animal welfare. Furthermore, current means to assess pain in rabbits are poor and more reliable methods are required. The objectives of this study were to assess the physiological and behavioural effects of ear tattooing on rabbits, evaluate the analgesic efficacy of topical local anaesthetic cream application prior to this procedure, and to develop a scale to assess pain in rabbits based on changes in facial expression.. In a crossover study, eight New Zealand White rabbits each underwent four different treatments of actual or sham ear tattooing, with and without prior application of a topical local anaesthetic (lidocaine/prilocaine). Changes in immediate behaviour, heart rate, arterial blood pressure, serum corticosterone concentrations, facial expression and home pen behaviours were assessed. Changes in facial expression were examined to develop the Rabbit Grimace Scale in order to assess acute pain. Tattooing without EMLA cream resulted in significantly greater struggling behaviour and vocalisation, greater facial expression scores of pain, higher peak heart rate, as well as higher systolic and mean arterial blood pressure compared to all other treatments. Physiological and behavioural changes following tattooing with EMLA cream were similar to those in animals receiving sham tattoos with or without EMLA cream. Behavioural changes 1 hour post-treatment were minimal with no pain behaviours identifiable in any group. Serum corticosterone responses did not differ between sham and tattoo treatments.. Ear tattooing causes transient and potentially severe pain in rabbits, which is almost completely prevented by prior application of local anaesthetic cream. The Rabbit Grimace Scale developed appears to be a reliable and accurate way to assess acute pain in rabbits.

Topics: Anesthetics, Local; Animals; Behavior, Animal; Cross-Over Studies; Face; Lidocaine; Lidocaine, Prilocaine Drug Combination; Ointments; Pain; Prilocaine; Rabbits; Tattooing

A variety of non-pharmacological pain-prevention and relief techniques have been studied to evaluate the pain reduction in neonates. The aim of our study was to compare the analgesic effect of sucking a pacifier with the use of eutectic mixture of local anaesthetics (EMLA) during venipuncture in preterm newborns, using physiological and behavioural parameters as indicators of pain.. We analysed the reaction to invasive procedures in 17 preterm newborns. Our patients underwent repeated vein draws without pain relief, sucking a pacifier, after the application of EMLA; we also evaluated a group of patients approached for care without pricking. For each infant we recorded the average values of the physiological parameters at rest and after pain stimuli, behavioural conditions (crying or grimaces), number and time required for blood draw.. The maximum heart rate values, respiratory rate, and the maximum respiratory rate values presented a statistically difference only between subjects that underwent vein draws compared to subjects without pricking (p < 0.01). Moreover, the SpO2 parameter presented a significant increase in the control group compared to the others (p = 0.024). Analysis ofbehavioural parameters shows that crying seems significantly related to the duration and number ofvenipunctures (p = 0.000).. It is clear that pain stress is more closely related to the duration and number of venipuncture than pain relief methods. Our results suggest that limiting the number and duration of vein draws could help to reduce pain stresss in preterm newborns.

Topics: Anesthetics, Local; Female; Humans; Infant, Newborn; Infant, Premature; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pacifiers; Pain; Phlebotomy; Prilocaine; Stress, Psychological

Topics: Anesthetics, Local; Bupivacaine; Glucocorticoids; Humans; Injections, Intralesional; Keloid; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Prilocaine; Punctures; Triamcinolone Acetonide

Alleviating pain is of high importance for children undergoing chemotherapy. Eutectic mixture of lidocain-prilocain cream (EMLA) is assumed to require 60 min application time.. We prospectively compared the pain during port-à-cath punctures after 40 min compared to 60 min of application time. A prospective, unblinded, cross-over study was performed. The children received two punctures during their chemotherapy protocol. Patients in group 1 had the first puncture after 40 min EMLA application time. Their second puncture (approximately a week later) was done after 60 min. Patients in group 2 started after 40 min. Pain was scored using the visual analogue scale (VAS) and the Bieri scale. Patients, parents and a nurse scaled the pain after the intervention. Eighty-seven children between 2 and 18 years with different malignant diseases were included.. On the VAS pain scale, the mean pain was 2.3 (minimum 0, maximum 9.2) after 40 min and 1.9 (minimum 0, maximum 9.4) after 60 min according to the observations of the nurse and very similarly according to the parents' observations. The children expressed more pain after 40 min of EMLA application time (mean pain, 3.5) and a significant pain reduction after 60 min application time (mean pain 1.7).. In this study children experienced less pain after 60 min application time, but pain reduction was already seen after 40 min. The child's perception of pain differed from observers' point of view and should therefore always be included in pain management.

Topics: Adolescent; Anesthetics, Local; Catheterization, Peripheral; Child; Child, Preschool; Cross-Over Studies; Drug Therapy; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Pain Measurement; Pain Perception; Pain Threshold; Prilocaine; Prospective Studies; Punctures; Time Factors; Treatment Outcome

To ascertain whether there is medical and religious agreement that neonates being circumcised should have anesthesia.. To enquire of pediatric and anesthetic surgical bodies and religious authorities, the need for and any objections to anesthesia.. Many neonatal circumcisions are still carried out without anesthesia worldwide. Muslims are recommended to be circumcised but it is not a religious requirement. It can be carried out at any time, by a surgeon and anesthetist. Jewish law requires circumcision (Bris) on the eighth day, by a Jewish circumciser (a mohel) and is usually, but not essentially, in the home.. All the medical authorities agree that anesthesia should be administered. Religious authorities cannot find any reasons to avoid anesthesia. The 'any day' request for anesthesia is difficult to meet with a shortage of pediatric anesthetists. Local anesthesia is suitable, but requires skills.. (i) That anesthesia should be provided for neonatal circumcision. (ii) That there will be difficulties in providing a professional service. (iii) That EMLA cream is the most practical, even if only partly effective. (iv) A website demonstrating application to parents would encourage usage.

Topics: Anesthesia; Anesthetics, Local; Ceremonial Behavior; Circumcision, Male; Humans; Infant, Newborn; Islam; Jews; Judaism; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Prilocaine

Topics: Anesthetics, Local; Catheterization; Catheters, Indwelling; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Nerve Block; Pain; Prilocaine; Radial Artery; Radial Nerve

To evaluate the effectiveness of an analgesic protocol with nitrous oxide and anaesthetic cream (lidocaine and prilocaine, EMLA) for children undergoing botulinum toxin injections.. Prospective study including 51 injection sessions, 34 children with a mean age of 5.94 (range 2-15) and 209 injected muscles. Pain was evaluated with the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS), the Visual Analogue Scale (VAS) and the Face Pain Scale (FPS) for the children and with a VAS for the parents.. CHEOPS score for the 51 sessions was 8.50 (S.D. 3.56). Forty-nine percent of scores were above the therapeutic threshold of 9; 25% of the children evaluated the pain above the therapeutic threshold of 3; 44.74% of the parents' estimations exceeded 3. No correlation was found between age, weight, number of injected muscle and CHEOPS score.. The association of MEOPA and anaesthetic cream is only effective for 50% of children. This is much lower than treatments for other types of acute induced pain in children. Botulinum toxin injections and cerebral palsy children present certain specificities which require improvements in this analgesic protocol.

Topics: Administration, Cutaneous; Administration, Inhalation; Adolescent; Anesthetics; Anti-Dyskinesia Agents; Botulinum Toxins; Cerebral Palsy; Child; Child, Preschool; Drug Therapy, Combination; Female; Humans; Injections, Intramuscular; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Nitrous Oxide; Oxygen Inhalation Therapy; Pain; Pain Measurement; Prilocaine; Prospective Studies; Risk Factors; Statistics, Nonparametric; Treatment Outcome

Perioperative analgesia in patients undergoing cleft lip and palate repair is complicated by the risk of postoperative airway obstruction. We describe a technique of combined infraorbital and external nasal nerve blocks to reduce the need for opioid analgesia. Using this technique, we have successfully performed cleft lip repair under local anesthesia alone, without general anesthesia or intravenous sedation, in adolescents and adults. In children, this technique can reduce the need for postoperative opioids. We describe this novel analgesic approach to decrease opioid requirements and minimize perioperative risk.

Topics: Adolescent; Adult; Anesthetics, Local; Cleft Lip; Female; Humans; Infant; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Nerve Block; Nose; Orbit; Pain; Pain Measurement; Prilocaine; Treatment Outcome

The purpose of this study was to investigate whether the application of heat placed to a child's potential intravenous (IV) site after the application of EMLA Cream™ decreases vasoconstriction, therefore promoting atraumatic care in the hospitalized pediatric patient. Venipuncture in children is a painful and frequently performed procedure. While use of EMLA Cream™ to reduce pain on insertion is a common practice with pediatric patients, no studies had measured venous size in relation to EMLA Cream™ and heat application. A descriptive quantitative design was used to examine the use of EMLA Cream™ and application of heat to facilitate venipuncture for peripheral venous cannulation. A convenience sample of 30 hospitalized Caucasian children, eight to twelve years old, participated. Vascular ultrasound directly measured the vein prior to and 1 hour after EMLA Cream™ application, as well as 2 minutes after heat application. Mean vein measurements were 0.243 cm prior to EMLA Cream™, 0.205 cm after EMLA Cream™ applied for 1 hour, and 0.253 cm after two minutes of heat. There was a significant increase in vein visualization from pre-application of heat to post application of heat with a success rate of 80% with the first time attempt of IV insertion. Therefore, application of heat counteracts the adverse effect of vasoconstriction that occurs with EMLA Cream™ application, potentially increasing peripheral venous cannulation success rates.

Topics: Anesthetics, Local; Child; Female; Humans; Hyperthermia, Induced; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Phlebotomy; Prilocaine

Sentinel lymph node biopsy (SLNB) has been reliably accurate as a minimally invasive surgical alternative for identifying lymphatic breast metastasis. During mapping, the injection of a radioactive tracer or isosulfan blue dye to differentiate the SLN is acutely painful. The use of the eutectic mixture of lidocaine and prilocaine (EMLA) cream to reduce tracer injection pain has been reported anecdotally. A retrospective study compared injection discomfort of 20 women who had undergone SLNB without EMLA and 20 women who had undergone SLNB with the EMLA protocol. Results indicated a significant difference in mean pain rating. Standards of care should include the use of EMLA prior to intradermal SLN tracer injection unless contraindicated.

Topics: Administration, Cutaneous; Anesthetics, Combined; Anesthetics, Local; Breast Neoplasms; Clinical Nursing Research; Drug Monitoring; Female; Humans; Injections, Intradermal; Lidocaine; Lidocaine, Prilocaine Drug Combination; Lymphatic Metastasis; Neoplasm Staging; Nurse's Role; Nursing Assessment; Occlusive Dressings; Oncology Nursing; Pain; Pain Measurement; Prilocaine; Radioisotopes; Radionuclide Imaging; Retrospective Studies; Sentinel Lymph Node Biopsy; Severity of Illness Index; Treatment Outcome

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.

Topics: Administration, Cutaneous; Anesthetics, Local; Attitude of Health Personnel; Catheterization, Peripheral; Child; Child, Preschool; Clinical Nursing Research; Equipment Design; Equipment Failure; Humans; Infant; Lidocaine; Lidocaine, Prilocaine Drug Combination; Nursing Evaluation Research; Nursing Staff, Hospital; Occlusive Dressings; Pain; Patient Selection; Pediatric Nursing; Polyurethanes; Prilocaine; Prospective Studies; Skin Care

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.

Topics: Adult; Anesthetics, Local; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Prilocaine; Prospective Studies; Treatment Failure; Vasectomy

Some children report significant pain with peripheral intravenous catheter (IV) insertion, despite the appropriate use of topical lidocaine anesthetics. This analysis of data from an existing study identified factors related to variation in topical anesthetic effectiveness used for IV insertion. The children (n = 218) in this investigation were 4 to 10 years old and undergoing a scheduled IV insertion. Inclusion criteria were (1) topical anesthetic was used according to manufacturer's recommendations, (2) DNA material was available, and (3) child completed a self-report measure of pain intensity (Oucher scale). Low pain phenotype was defined as a pain intensity score of 0 to 3, and high pain phenotype was an intensity score of 4 to 10. Potential predictor variables included child age, gender, number of previous painful procedures, state and trait anxiety, temperament characteristics, and alleles in 3 candidate genes in a pain pathway influenced by topical anesthetics (endothelin-1 [EDN1], endothelin receptor A [EDNRA], endothelin receptor B [EDNRB]). All subjects were genotyped for a single-nucleotide polymorphism in each gene. Children in the high pain group (n = 89) were significantly younger (P < .0001), more active (P = .0029), scored higher for trait (P = .0009) and state anxiety (P = .0312), and had the EDNRA TT genotype (high pain group, TT 67.35%; low pain group, TT 39.47%; P = .026).. The identification of factors that influence peripheral pain sensation aids in selecting the most appropriate pharmacologic and nonpharmacologic interventions. Until genotyping is available at a clinically prescriptive level, other predictors (eg, age and activity level) can be used to tailor pain-relieving strategies for children undergoing needle sticks.

Topics: Administration, Topical; Age Factors; Anesthetics, Local; Anxiety; Catheterization, Peripheral; Child; Child, Preschool; Drug Resistance; Endothelin-1; Female; Gene Frequency; Genotype; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Pain Threshold; Phenotype; Predictive Value of Tests; Prilocaine; Receptor, Endothelin A; Receptor, Endothelin B; Regression Analysis; Sex Factors; Temperament

Topics: Anesthetics, Local; Child; Child, Preschool; Glucose; Humans; Infant; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Parents; Prilocaine; Solutions; Vaccination

To compare the effect of eutectic mixture of local anaesthetics (EMLA) and a placebo cream on reported pain and observed distress associated with venepuncture, and to investigate effects of procedural information before and distraction during venepuncture.. Children 3-12 years of age undergoing venepuncture under five experimental and a control condition reported their pain at venepuncture on visual scales. Distress was observed when the child entered the waiting room, just before, and during venepuncture.. Distress increased over the measurement occasions, but a distress-reducing effect of EMLA only was found at the actual venepuncture. The placebo diminished the reported pain, but the effect of EMLA was larger. Procedural information and distraction showed no effects.. EMLA reduces pain from venepuncture. The placebo effect probably results from desirable responding. Behavioural distress is a more direct measure than self-reported pain. More sophisticated designs should be used for the provision of procedural information and distraction.

Topics: Anesthetics; Anesthetics, Combined; Anesthetics, Local; Child; Child Behavior; Child, Preschool; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Phlebotomy; Placebos; Prilocaine; Psychology, Child; Stress, Psychological; Treatment Outcome

Topics: Anesthetics, Combined; Biopsy, Needle; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Prilocaine; Prostate; Prostatic Neoplasms; Randomized Controlled Trials as Topic

Topics: Age Factors; Analgesia; Anesthetics, Local; Attitude of Health Personnel; Benchmarking; Blood Specimen Collection; Child; Child, Preschool; Humans; Infant; Lidocaine; Lidocaine, Prilocaine Drug Combination; Nursing Evaluation Research; Nursing Staff, Hospital; Pain; Paris; Patient Education as Topic; Pediatric Nursing; Prilocaine; Surveys and Questionnaires

Topics: Adolescent; Anesthetics, Local; Child; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Ointments; Pain; Phlebotomy; Prilocaine

Topics: Anesthetics, Combined; Anesthetics, Local; Arteriovenous Shunt, Surgical; Hemodialysis, Home; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Phlebotomy; Prilocaine; Self Administration

Scaling and root planing is a common procedure in clinical practice. Despite the frequency of the procedure, the control of pain associated with scaling and root planing has not been well studied. Recently, studies have pointed out a need for pain control during the procedure in a significant number of subjects-perhaps as many as 30% of patients. This need for pain control is similar to the need for instrumentation during maintenance therapy. The need also is similar whether hand instrumentation or ultrasonic equipment is used. The current most used form of pain control is local anesthesia injections. However, many patients object to the use of "the needle." Therefore, there is a need for a noninjectable form of pain control that is effective.

Topics: Administration, Topical; Anesthetics, Combined; Anesthetics, Local; Dental Scaling; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Ointments; Pain; Periodontal Diseases; Prilocaine; Root Planing; Ultrasonic Therapy

In recent years, three multicenter studies have been conducted to evaluate the clinical efficacy of an active 5% dental gel to reduce pain when placed into periodontal pockets before initiating scaling and root planing procedures. In each of the clinical studies, the researchers found statistically significant differences between the pain scores of the active dental gel group and the placebo gel group that favored the active gel for the control of pain during periodontal scaling and root planing procedures. This article reviews each of the three studies and highlights some of the differences among them.

Topics: Administration, Topical; Anesthetics, Combined; Anesthetics, Local; Clinical Trials as Topic; Dental Scaling; Double-Blind Method; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Multicenter Studies as Topic; Ointments; Pain; Pain Measurement; Periodontal Pocket; Periodontitis; Placebos; Prilocaine; Randomized Controlled Trials as Topic; Root Planing; Treatment Outcome

Topics: Anesthetics, Combined; Anesthetics, Local; Circumcision, Male; Evidence-Based Medicine; Heart Rate; Humans; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Prilocaine

Whether a component of a disease process, the result of acute injury, or a product of a diagnostic or therapeutic procedure, pain should be relieved and stress should be decreased for pediatric patients. Control of pain and stress for children who enter into the emergency medical system, from the prehospital arena to the emergency department, is a vital component of emergency care. Any barriers that prevent appropriate and timely administration of analgesia to the child who requires emergency medical treatment should be eliminated. Although more research and innovation are needed, every opportunity should be taken to use available methods of pain control. A systematic approach to pain management and anxiolysis, including staff education and protocol development, can have a positive effect on providing comfort to children in the emergency setting.

Topics: Administration, Oral; Analgesics; Anesthetics, Combined; Anxiety; Child; Conscious Sedation; Emergency Medical Services; Emergency Medicine; Epinephrine; Humans; Infant; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Pain Measurement; Prilocaine; Sucrose; Tetracaine

Topics: Administration, Cutaneous; Age Factors; Anesthetics, Combined; Anesthetics, Local; Child; Child, Preschool; Contraindications; Drug Administration Schedule; Drug Monitoring; Humans; Infant; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Ointments; Pain; Patient Selection; Pediatric Nursing; Prilocaine; Time Factors

Topics: Ambulatory Surgical Procedures; Anesthetics, Local; Child; Child, Preschool; Dilatation; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Pain Measurement; Prilocaine; Urethral Stricture

The aim of the study was to investigate the perceptual integration of simultaneous stimulation in a focal and a referred pain area to investigate whether referred pain is mainly caused by facilitation of on-going input from the referred pain area by stimulation in the focal pain area or if referred pain is a consequence of misinterpretation of the origin of inputs from the focal pain area. Pain was induced in twelve healthy individuals by intramuscular electrical stimulation in the left infraspinatus muscle (MI) or the left dorsolateral upper arm (UA), i.e. the area of referral commonly reported from stimulation in MI. Conditioning stimulation consisted of, in a counterbalanced order, no stimulation (baseline) and pain intensity rated as 2/10 and 4/10, respectively, on a category scale. During conditioning stimulation in MI, sensitivity to test stimuli was assessed in UA and vice versa. The test stimuli consisted of i.m. electrical stimulation corresponding to the perception threshold to innocuous electrical stimulation, the electrical pain threshold (EPT), and pain intensity rated as 2/10, 4/10 and 6/10, respectively. Conditioning stimulation corresponding to 2/10 did not result in a statistically significant change in sensitivity to any test stimuli in either location. During conditioning stimulation corresponding to 4/10 in m. infraspinatus, all twelve subjects reported referred pain in the dorsolateral upper arm. Compared to baseline, EPTs decreased in the referred pain area (P<0.001), while no other statistically significant changes in sensitivity to test stimuli were seen. Conditioning stimulation corresponding to 4/10 in the dorsolateral upper arm gave rise to referred pain in one individual (area of m. biceps brachii), and no statistically significant changes were seen in the sensitivity to electrical stimuli in m. infraspinatus. In conclusion, an effect at pain threshold level only was documented during simultaneous stimulation in the focal and referred pain area, which does not support facilitation of inputs from the referred pain area as the main mechanism generating referred pain. Instead, referred pain is most likely a consequence of misinterpretation of the origin of input from the stimulated focal pain area, due to excitation of neurones somewhere along the neuroaxis with projected fields in the referred pain area. The fact that conditioning stimulation in m. infraspinatus generated referred pain in the dorsolateral upper arm, but not vice

Topics: Adult; Anesthetics, Local; Arm; Conditioning, Psychological; Electric Stimulation; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Muscle, Skeletal; Ointments; Pain; Pain Measurement; Pain Threshold; Prilocaine; Reference Values; Sensory Thresholds; Shoulder

Topics: Anesthesia, Local; Anesthetics, Local; Debridement; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Ointments; Pain; Prilocaine

Topics: Age Distribution; Aged; Anesthetics, Local; Bandages; Debridement; Humans; Leg Ulcer; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Prevalence; Prilocaine; Skin Care; Wound Healing

A short cut review was carried out to establish whether there is any evidence to show that stripping the stratum corneum with adhesive tape reduces time to analgesia after application of EMLA in children undergoing venepuncture. Altogether 43 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this paper are tabulated. A clinical bottom line is stated.

Topics: Anesthetics, Local; Child, Preschool; Evidence-Based Medicine; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Prilocaine

Topics: Anesthetics, Local; Capsaicin; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Prilocaine

Topics: Anesthetics, Local; Carpal Tunnel Syndrome; Decompression, Surgical; Humans; Injections; Lidocaine; Lidocaine, Prilocaine Drug Combination; Ointments; Pain; Pain Measurement; Prilocaine

Topics: Adult; Anesthetics, Combined; Female; Hemorrhoids; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Prilocaine; Thrombosis

Topics: Anesthetics, Local; Child; Child Welfare; Emergency Medical Services; Feasibility Studies; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Prilocaine

Topics: Anesthetics, Local; Child Advocacy; Circumcision, Male; Humans; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Prilocaine; Treatment Outcome

Topics: Anesthetics, Local; Circumcision, Male; Humans; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Prilocaine

Topics: Anesthetics, Local; Hand; Heel; Humans; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Phlebotomy; Prilocaine; Research Design

Topics: Analgesia; Anesthetics, Local; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Prilocaine; Spinal Puncture

We studied the impact of age-related factors and the benefits of 50% nitrous oxide or EMLA cream in 108 children undergoing preoperative laboratory testing. Procedural pain was assessed by behavioural scores (CHEOPS) and pain intensity ratings. Age, preexisting behavioural distress and difficulty of venous access were significant predictors of outcome in univariate analysis. Nitrous oxide and EMLA cream were both effective in lowering pain related behaviour and pain ratings generated by the different adult observers and the children where applicable. EMLA cream was more effective than 50% nitrous oxide in children 1-4 years old. Although EMLA cream was responsible for a 28+/-5 min prolongation of waiting time at the clinic, the present results suggest that it should remain the first line intervention to alleviate pain from venepuncture in paediatric outpatients.

Topics: Adult; Age Factors; Analysis of Variance; Anesthetics, Combined; Anesthetics, Inhalation; Anesthetics, Local; Child; Child Behavior; Child, Preschool; Crying; Facial Expression; Female; Forecasting; Humans; Infant; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Movement; Needles; Nitrous Oxide; Outcome Assessment, Health Care; Pain; Pain Measurement; Phlebotomy; Preoperative Care; Prilocaine; Stress, Psychological; Time Factors; Verbal Behavior

Topics: Anesthetics, Combined; Anesthetics, Local; Debridement; Humans; Leg Ulcer; Lidocaine; Lidocaine, Prilocaine Drug Combination; Occlusive Dressings; Pain; Prilocaine; Research Design; Treatment Outcome

This study compared distraction, an anesthetic (eutectic mixture of local anesthetics [EMLA]), and typical care during pediatric immunizations. Participants were 39 4th graders receiving a 3-injection vaccination series over a 6-month period. Children displayed low distress despite reporting moderate anxiety and pain. Distraction resulted in more nurse coaching and child coping and less child distress than did EMLA or typical care on an observational measure. EMLA did not result in increased child coping or decreased distress. In fact, the nurse coached more, and trends suggested that children coped more with typical care than with EMLA. Whereas participant ratings and heart rate did not differ among conditions, all 3 conditions demonstrated improvements over time with these measures. Satisfaction ratings suggested that children preferred the treatments to typical care, whereas the nurse appreciated aspects of each of the conditions. Finally, distraction was more economical than EMLA.

Topics: Anesthetics, Local; Anxiety; Child; Child Behavior; Female; Humans; Immunization; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Patient Satisfaction; Prilocaine; Stress, Psychological

Topics: Anesthetics, Combined; Circumcision, Male; Heart Rate; Humans; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Prilocaine

Topics: Anesthetics, Combined; Anesthetics, Local; BCG Vaccine; Child; Child, Preschool; Female; Humans; Infant; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Prilocaine; Vaccination

Topics: Anesthetics, Local; Child; Child, Preschool; Female; Humans; India; Infant; Infant, Newborn; Injections; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Prilocaine; Vaccination

Topics: Anesthesia, Local; Anesthetics, Local; Circumcision, Male; Drug Combinations; Humans; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Prilocaine; Stress Disorders, Post-Traumatic

Topics: Anesthetics, Local; Circumcision, Male; Drug Combinations; Humans; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Nerve Block; Pain; Penis; Prilocaine

Topics: Anesthetics, Local; Catheterization, Central Venous; Catheters, Indwelling; Drug Combinations; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Oncology Nursing; Pain; Prilocaine

Topics: Anesthesia, Local; Anesthetics, Combined; Anesthetics, Local; Circumcision, Male; Humans; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Prilocaine

Topics: Anesthetics, Local; Child; Drug Combinations; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Phlebotomy; Prilocaine

Lumbar puncture is a common procedure in pediatric onco-hematology. Repeated invasive painful procedures may contribute to increase distress displayed during medical treatment, and cause regression, depression and other psychological disorders.. A two-year workshop of the Société française d'oncologie pédiatrique was reviewed through a questionnaire assessing changes in technical management of lumbar puncture, local anesthesia, sedation and cognitive-behavioral interventions.. Significant changes were found for pain assessment, local anesthesia procedures, and nitrous oxide administration. The extensive use of the Emla cream largely contributed to reduce pain. Anxiety however remained an unsolved problem, particularly among young children.. Pain in pediatrics remains a major challenge. This workshop is a model of reflexion to achieve a better management of pain during invasive medical procedures.

Topics: Anesthetics, Local; Child; Drug Combinations; Humans; Hypnotics and Sedatives; Lidocaine; Lidocaine, Prilocaine Drug Combination; Nitrous Oxide; Pain; Pain Management; Premedication; Prilocaine; Spinal Puncture

The effectiveness of a Eutectic Mixture of Local Anaesthetics (EMLA cream) for pain control during renal extracorporeal shock wave lithotripsy (ESWL) was evaluated in a group of 20 patients who had not been able to tolerate a previous session without intravenous (i.v.) analgesia. EMLA cream (10 g) was applied on the skin over the area (64-100 cm2) where the shock waves were to be focussed. A second generation lithotriptor Siemens Lithostar was used. The following measurements were made: the shock wave (kV) maximum voltage, the number of successful stone fragmentations (SSF), the visual analogue scale score (0-10) for pain (VAS), and the tolerance scale score (1-4) for the tolerance for the procedure. Significantly higher voltage (17.9 +/- 0.6 kV vs. 16.2 +/- 0.8 kV), lower VAS scores (5.9 +/- 1.1 vs. 8.7 +/- 1.3), lower TS score (2.3 +/- 0.6 vs. 3.6 +/- 0.6) and a higher number of SSF (18 vs. 5) were found in those patients for whom EMLA cream was used. Intravenous analgesia was not needed in nine patients. Nine patients received fentanyl 0.05 mg, one 0.10 mg and another 0.15 mg. These favourable results were attributed both to the sequence of gradual voltage increments used and to the cutaneous analgesia produced by EMLA cream.

Topics: Ambulatory Care; Analgesia; Analgesics, Opioid; Anesthetics, Local; Drug Combinations; Female; Fentanyl; Humans; Injections, Intravenous; Kidney Calculi; Lidocaine; Lidocaine, Prilocaine Drug Combination; Lithotripsy; Male; Middle Aged; Ointments; Pain; Pain Measurement; Prilocaine; Single-Blind Method

The national Swedish screening programme for inborn errors of metabolism includes blood sampling from all neonates. Heel lancing has hitherto been the method of choice for these screening tests. Studies have recently been done to find out whether the use of EMLA can alleviate pain caused by heel lancing. EMLA had little, if any effect when applied to the heel of full term babies. Similar results were reported concerning preterm infants. Other authors have found that differences in skin thickness or in skin blood perfusion may influence the effect of EMLA. The aim of this study was to establish whether differences in skin thickness or in skin blood perfusion were present in three regions: the forehead, the dorsum of the hand and the heel. Ten healthy full term neonates were included in the study on skin perfusion. Measurements were made with a laser Doppler flux meter. Twenty-seven healthy full term neonates were included for measurements of skin thickness using a high frequency B-mode ultrasonic meter. The heel skin perfusion was two to three times higher than the skin perfusion at the dorsum of the hand and at the forehead but there was no significant difference when comparing skin thickness of the heel with the dorsum of the hand and the forehead. A rapid clearance of a topically applied local anaesthetic, due to high cutaneous blood flow, may explain why EMLA seems to be of little value when it is applied to the neonatal heel.

Topics: Anesthesia, Local; Anesthetics, Local; Blood Specimen Collection; Drug Combinations; Female; Forehead; Hand; Heel; Humans; Infant, Newborn; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Prilocaine; Regional Blood Flow; Skin; Ultrasonography

Electric transcranial stimulation (TCS) is useful for clinical studies. It is, however, painful and not generally used for awake subjects. By means of topical anaesthesia and nerve blockades we wanted to find out which structures of the scalp and cranium are sensitive to electric TCS. Altogether 21 subjects participated in the present study. Our data show that pain experienced by the subjects during electric TCS is brought about by activation of the pain receptors in the scalp under the stimulating electrodes. Topical anaesthetic cream is incapable of attenuating this pain. The periosteum does not seem to be much more sensitive electric stimulation than rest of the scalp. Furthermore, contractions of facial and neck muscles do not seem to have a significant role in pain generation in electric TCS. Pain can be prevented if sufficiently large areas of the scalp are properly anaesthetized before stimulation by e.g. blockade of the major nerves responsible for the sensation of the stimulus area.

Topics: Adult; Anesthesia, Local; Anesthetics, Local; Bupivacaine; Drug Combinations; Electric Stimulation; Facial Muscles; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Muscle Contraction; Neck Muscles; Nerve Block; Nociceptors; Occipital Bone; Ointments; Pain; Pain Measurement; Pain Threshold; Periosteum; Prilocaine; Scalp; Sensation; Skull

A 44-year-old man presented with a history of sudden onset left flank pain, accompanied by nausea and microhematuria. The diagnosis of ureteropelvic junction calculus was made and the patient was scheduled for extracorporeal shock wave lithotripsy (ESWL). ESWL uses an electrical spark to generate a shock wave that is focused on a stone in the ureter or kidney. The shock waves mechanically stress and crush the stone, eliminating the need for manipulation or open procedure. The pain of ESWL is caused by skin sensation. Eutectic mixture of local anesthetics (EMLA) cream (2.5% lidocaine and 2.5% prilocaine) has been used as a topical anesthetic on intact skin for various minor procedures. Studies have shown that it is effective in dramatically decreasing or eliminating the pain of ESWL. The use of topical EMLA as an anesthetic management technique for a patient undergoing ESWL is described.

Topics: Administration, Cutaneous; Adult; Anesthetics, Local; Drug Combinations; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Lithotripsy; Male; Pain; Prilocaine

Topics: Acquired Immunodeficiency Syndrome; Adult; Anesthetics, Local; Drug Combinations; Humans; Injections, Subcutaneous; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Pain; Prilocaine

Laser therapy is now accepted as the treatment of choice for port wine stains. Patient reaction to laser light exposure and methods used to control pain during 1357 treatment sessions for 350 medium to large port wine stains using the SPTL-1 laser (Candela Laser Corporation) are reported. In the majority of cases (86%) it was necessary to use either general anaesthesia or some other form of local pain control.

Topics: Adolescent; Adult; Aged; Anesthesia, General; Anesthesia, Local; Anesthetics, Local; Child; Child, Preschool; Drug Combinations; Facial Dermatoses; Hamartoma; Humans; Ice; Laser Therapy; Lasers; Lidocaine; Lidocaine, Prilocaine Drug Combination; Middle Aged; Pain; Prilocaine; Skin Diseases

Topics: Anesthetics, Local; Child; Child, Preschool; Drug Combinations; Humans; Infant; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Prilocaine

Topics: Anesthetics, Local; Child; Drug Combinations; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Pediatric Nursing; Prilocaine

We have compared the efficacy of two non-invasive methods of transdermal anaesthesia: application of EMLA cream and iontophoresis of 5% lignocaine with adrenaline 1:50,000 in six healthy subjects. We tested depth of tissue penetration (pinprick) and effect on pain evoked by i.v. injection. After iontophoresis, pain on i.v. injection was abolished in five of six volunteers, whereas EMLA had no effect. We conclude that local anaesthetics penetrate deeply enough to numb both veins and skin with iontophoresis only.

Topics: Adult; Anesthesia, Local; Anesthetics, Local; Drug Combinations; Epinephrine; Female; Humans; Injections, Intravenous; Iontophoresis; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Prilocaine

Topics: Anesthetics, Local; Child; Drug Combinations; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Needles; Pain; Prilocaine; Punctures

EMLA cream (Eutectic Mixture of Local Anesthetics) is a new topical anesthetic composed of 25 mg lidocaine and 25 mg prilocaine in an oil-in-water emulsion cream. It has been found to be very effective for local anesthesia prior to venepuncture, minor surgical procedures, and pulsed dye laser (PDL) therapy for port-wine stains (PWS) in children. However, since EMLA may cause vasoconstriction of cutaneous vessels, we tried to determine whether pretreatment with EMLA decreases the efficacy of subsequent PDL treatment. We report eight patients between the ages of 4 and 32 years with PWS who received two test site treatments prior to PDL treatment. One site was pretreated with EMLA cream under occlusion for 60 minutes and then left unoccluded for 15 minutes prior to PDL test treatment. The other site, in the same area of the PWS and patient's body, was not pretreated with EMLA. The test sites were compared 6-8 weeks later to determine whether EMLA decreased the degree of lightening of the PWS compared to the non-EMLA-treated site. We conclude that EMLA is an effective topical anesthetic for PDL treatment of PWS and does not adversely affect the efficacy of the treatment.

Topics: Administration, Topical; Adolescent; Adult; Anesthetics, Local; Child; Child, Preschool; Drug Combinations; Female; Hemangioma; Humans; Laser Therapy; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Prilocaine; Skin Neoplasms

The analgesic effects of intradermal lidocaine infiltration and topical EMLA cream applications (eutectic mixture of local anaesthetics) were studied in 8 patients with Ehlers Danlos syndrome type III, a heritable disorder of connective tissue, and in 8 controls. Cutaneous analgesia was evaluated by sensory and pain thresholds to short argon laser stimulation, and the depth of cutaneous analgesia was measured by sensory and pain thresholds to controlled needle insertion. Five minutes after lidocaine infiltration, the laser-induced pain was abolished in both groups, but 1 h later only the skin of the controls remained analgesic. EMLA cream was applied for 30, 60, and 120 min, but none of the patients obtained sufficient analgesia. Full analgesia was obtained for the controls after 60 and 120 min of application. The depth of cutaneous EMLA analgesia was significantly less for the patients compared to controls. The present quantitative findings support clinical observations that long-lasting cutaneous analgesia is difficult to obtain for this group of patients.

Topics: Adult; Anesthetics, Local; Drug Combinations; Ehlers-Danlos Syndrome; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Prilocaine