Abstract
Eutectic mixture of local anaesthetics (EMLA) cream with Tegaderm was compared with prepackaged 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 threepoint 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.
Résumé
Cette étude compare l’efficacité, l’adhésivité et les réactions locales du mélange eutectique de crème d’anesthésiques locaux (EMLA) appliqué sous une pellicule de Tegaderm avec un timbre préenduit d’EMLA au regard de l’effet analgésique, l’adhésivité, et des réactions locales lors d’une ponction veineuse réalisée chez 178 enfants âgés de trois à dix ans. Un timbre ou la moitié d’un tube de 5 g de crème EMLA avec Tegaderm est appliqué au dos de la main ou au pli du coude pendant au moins 60 min avant la ponction. Le sujet et l’observateur évaluent la douleur sur une échelle verbale à trois degrés. L’adhérence cutanée du timbre et celle du Tegaderm et les réactions locales sont enregistrées. On ne trouve pas de différence entre les deux groupes au regard de la douleur: 95% du groupe EMLA-timbre et 94% du groupe EMLA-crème ne rapportent que peu ou pas de douleur. Il n’y a pas de différence entre les groupes au regard des réactions locales. Le timbre adhère moins bien (P < 0,001), mais ceci n’a aucune influence apparente sur l’efficacité. En conclusion, le timbre EMLA équivaut à la crème (2,5 g) pour le soulagement de la douleur cutanée lorqu’on les utilise pour la ponction veineuse chez l’enfant.
Article PDF
Similar content being viewed by others
References
Evers H, von Dardel O, Juhlin L, Ohlsén L, Vinnars E. Dermal effects of compositions based on the eutectic mixtures of lignocaine and prilocaine (EMLA). Br J Anaesth 1985; 57: 997–1005.
Hallén B, Carlsson P, Uppfeldt A. Clinical study of a lignocaine-prilocaine cream to relieve the pain of venepuncture. Br J Anaesth 1985; 57: 326–8.
Rosdahl I, Edmar B, Gisslén H, Nordin P.Lillieborg S. Curettage of molluscum contagiosum in children: analgesia by topical application of a lidocaine/prilocaine cream (EMLA). Acta Derm Venereol (Stockh) 1988; 68: 149–53.
Wagner G, Mensing H. Perkutane anaesthesie durch anwendungeiner lidocain-prilocain-creme (EMLA creme 5%) — Erfahrungen bei der therapie multipeler mollusca contagiosa im kindesalter. Acta Dermatol 1989; 15: 44–6.
de Waard-van der Spek FB, Oranje AP, Lillieborg S, Hop WCJ, Stolz E. Treatment of molluscum contagiosum using a lidocaine/prilocaine cream (EMLA) for analgesia. J Am Acad Dermatol 1990; 23: 685–8.
Juhlin L, Evers H, Broberg F. A lidocaine-prilocaine cream for superficial skin surgery and painful lesions. Acta Derm Venereol (Stockh) 1980; 60: 544–6.
Ehrenström Reiz GME Reiz SLA. EMLA — a eutectic mixture of local anaesthetics for topical anaesthesia. Acta Anaesthesiol Scand 1982; 26: 596–8.
Hellgren U, Kihamia CM, Premji Z, Danielson K. Local anaesthetic cream for the alleviation of pain during venepuncture in Tanzanian schoolchildren. Br J Clin Pharmacol 1989; 28: 205–6.
Hallén B, Olsson GL, Uppfeldt A. Pain-free venepuncture. Effect of timing of application of local anaesthetic cream. Anaesthesia 1984; 39: 969–72.
Cooper CM, Gerrish SP, Hardwick M, Kay R. EMLA cream reduces the pain of venepuncture in children. Eur J Anaesthesiol 1987; 4: 441–8.
Hopkins CS, Buckley CJ, Bush GH. Pain-free injection in infants. Use of lignocaine-prilocaine cream to prevent pain at intravenous induction of general anaesthesia in 1–5-yearold children. Anaesthesia 1988; 43: 198–201.
Hallén B, Uppfeldt A. Does lidocaine-prilocaine cream permit painfree insertion of IV catheters in children? Anesthesiology 1982; 57: 340–2.
Manner T, Kanto J, Lisalo R, Lindberg R, Viinamäki O, Scheinin M. Reduction of pain at venous cannulation in children with eutectic mixture of lidocaine and prilocaine (EMLA cream): comparison with placebo cream and no local premedication. Acta Anaesthesiol Scand 1987; 31: 735–9.
Maunuksela EL, Korpela R. Double-blind evaluation of lignocaine-prilocaine cream (EMLA) in children. Effect on the pain associated with venous cannulation. Br J Anaesth 1986; 58: 1242–5.
Clarke S, Radford M. Topical anaesthesia for venepuncture. Arch Dis Child 1986; 61: 1132–4.
Kapelushnik J, Koren G, Solh H, Greenberg M, DeVeber L. Evaluating the efficacy of EMLA in alleviating pain associated with lumbar puncture; comparison of open and double-blinded protocols in children. Pain 1990; 42: 31–4.
Halperin DL, Koren G, Attias D, Pellegrini E, Greenberg ML, Wyss M. Topical skin anesthesia for venous, subcutaneous drug reservoir and lumbar punctures in children. Pediatrics 1989; 84: 282–4.
MacKinlay GA. Save the prepuce. Painless separation of preputial adhesions in the outpatient clinic. BMJ 1988; 297: 590–1.
Fitzgerald M, Millard C, McIntosh N. Cutaneous hypersensitivity following peripheral tissue damage in newborn infants and its reversal with topical anaesthesia. Pain 1989; 39: 31–6.
Bjerring P, Arendt-Nielsen L. Depth and duration of skin analgesia to needle insertion after topical application of EMLA cream. Br J Anaesth 1990; 64: 173–7.
Jones SK, Handfield-Jones S, Kennedy CTC. Does EMLA reduce the discomfort associated with localanaesthetic infiltration? Clin Exp Dermatol 1990; 15: 177–9.
Nykanen D, Kissoon N, Rieder M, Armstrong R. Comparison of a topical mixture of lidocaine and prilocaine (EMLA) versus 1% lidocaine infiltration on wound healing. Pediatr Emerg Care 1991; 7: 15–7.
Klingman AM. Topical pharmacology and toxicology of dimethyl sulphonate — Part I. JAMA 1956; 193: 140–3.
Monash S. Topical anesthesia of the unbroken skin. Arch Dermatol 1957; 76: 752-?
Brechner VL, Cohen DD, Pretsky I. Dermal anesthesia by the topical application of tetracaine base dissolved in dimethyl sulphoxide. Ann N Y Acad Sci 1967; 141: 524–31.
Dalili H, Adriani J. The efficacy of local anesthetics in blocking the sensation of itch, burning, and pain in normal and “sunburned” skin. Clin Pharmacol Ther 1971; 12: 913–9.
Russo J Jr, Lipman AG, Comstock TJ, Page BC, Stephen RL. Lidocaine anesthesia: comparison of iontophoresis, injection, and swabbing. Am J Hosp Pharm 1980; 37: 843–7.
Brodin A, Nyqyist-Mayer A, Wadsten T, Forslund B, Broberg F. Phase diagram and aqueous solubility of the lidocaine-prilocaine binary system. J Pharm Sci 1984; 73: 481–4.
Jakobson B, Nilsson S. Methemoglobinemia associated with a prilocaine-lidocaine cream and trimetoprimsulphamethoxazole: a case report. Acta Anaesthesiol Scand 1985; 29: 453–5.
Engberg G, Danielson K, Henneberg S, Nilsson A. Plasma concentrations of prilocaine and lidocaine and methaemoglobin formation in infants after epicutaneous application of a 5% lidocaine-prilocaine cream (EMLA). Acta Anaesthesiol Scand 1987; 31: 624–8.
Norman J, Jones PL. Complications of the use of EMLA (Letter). Br J Anaesth 1990; 64: 403.
James IG. EMLA: Complications (Letter). Br J Anaesth 1990; 65: 295.
Author information
Authors and Affiliations
Additional information
Financial support for this multicentre study was provided by ASTRA Pharma Inc. Canada.
Rights and permissions
About this article
Cite this article
Chang, P.C., Goresky, G.V., O’Connor, G. et al. A multicentre randomized study of single-unit dose package of EMLA patch vs EMLA 5% cream for venepuncture in children. Can J Anaesth 41, 59–63 (1994). https://doi.org/10.1007/BF03009664
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03009664