Title: Comparison of Pain Score in Differently Timed EMLA Cream Application in Pediatric Age Group

Authors: Dr Sheela Verghese, Dr Shamim Kunhu. V

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i4.32

Abstract

Background: Securing a safe and patent intravenous access for drug and fluid administration is one of the most important pre requisites of delivering anesthesia to any patient. Intravenous cannulation is now performed almost universally before induction of anesthesia. This procedure has been reported to produce significant pain especially in pediatric population. Therefore it would be appropriate to use percutaneous anesthetic agents

Methods and Material: The efficacy of a topical anesthetic formulation, EMLA 5% cream (Eutectic Mixture of Local Anaesthetics), in obtunding the pain produced by intravenous cannulation was evaluated in our observational study. Pain scores were compared in total 50 patients with EMLA cream applied 30 minutes and 60 minutes prior to venous cannulation

Results: Patients in whom EMLA was applied 60 minutes prior to cannulation had the lowest pain score value with68% having pain score 0. Significant analgesia were produced in both 30minutes and 60 minutes group as shown by pain score 0&1, with 76% and 88% respectively

Conclusions: We recommend the use of EMLA cream prior to venepuncture in all pediatric patients. For maximum analgesic effect, EMLA should be applied for 60 minutes. Satisfactory analgesia can achieved after 30 minutes

Keywords: EMLA, cannulation, pain.

References

1.      Molodecka J, Stenhouse C, Jones J, Tomlinson A. Comparison of percutaneous anaesthesia for venous cannulation after topical application of either amethocaine or EMLA cream. BJA: British Journal of Anaesthesia. 1994;72(2):174-176.

2.      Bond M, Crathorne L, Peters J, Coelho H, Haasova M, Cooper C et al. First do no harm: pain relief for the peripheral venous cannulation of adults, a systematic review and network meta­analysis. BMC Anesthesiology. 2015;16(1).

3.      Kennedy R, Luhmann J, Zempsky W. Clinical Implications of Unmanaged Needle-lnsertion Pain and Distress in Children. Pediatrics. 2008;122 (Supplement): S130-S133.

4.      Harrison N, Langham B, Bogod D. Appropriate Use of Local Anesthetic for Venous Cannulation. Survey of Anesthesiology. 1993;37(2):111.

5.      Hopkins C, Buckley C, Bush G. Pain-free injection in infants. Anaesthesia. 2007;43(3):198-201.

6.      Zempsky W. Pharmacologic Approaches for Reducing Venous Access Pain in Children. Pediatrics. 2008;122 (Supplement) :S140-S153.

7.      Cordoni ACordoni L. Eutectic Mixture of Local Anesthetics Reduces Pain During IntravenousCatheter Insertion in the Pediatric Patient. The Clinical Journal of Pain. 2001;17(2):115-118.

8.      Sharma S, Gambling D, Gajraj N, Wallace D, Sidawi E, Herrera E et al. EMLA Cream Effectively Relieves the Pain of Spinal Needle Insertion. Anesthesiology. 1994;81(Supplement):A1004

Corresponding Author

Dr Sheela Verghese

Additional Professor, Dept of Anesthesiology and Critical Care

Government Medical College Thiruvananthapuram