Annals of Emergency Medicine
Volume 46, Issue 4 , Pages 343-351 , October 2005

Topical Anesthetics for Dermal Instrumentation: A Systematic Review of Randomized, Controlled Trials

  • Anthony Eidelman, MD
  • ,
  • Jocelyn M. Weiss, MPH
  • ,
  • Joseph Lau, MD
  • ,
  • Daniel B. Carr, MD

      Affiliations

    • Corresponding Author InformationAddress for correspondence: Daniel B. Carr, MD, Tufts–New England Medical Center, Department of Anesthesiology and Pain Medicine, 750 Washington Street, Tufts-NEMC #298, Boston, MA, 02111; 617-636-9710, fax 617-636-9709

Received 21 June 2004 ,Revised 5 January 2005 ,Accepted 17 January 2005.

References 

  1. Ashburn MA. Burn pain: the management of procedure related pain. J Burn Care Rehabil. 1995;16:365–371
  2. Kundu S, Achar S. Principles of office anesthesia, part II: topical anesthesia. Am Fam Physician. 2002;66:99–102
  3. Van Kan H, Egberts A, Rijnvos W, et al. Tetracaine versus lidocaine-prilocaine for preventing venipuncture-induced pain in children. Am J Health Syst Pharm. 1997;54:388–392
  4. Koren G. Use of the eutectic mixture of local anesthetics in young children for procedure-related pain. J Pediatr. 1993;122:S30–S35
  5. Gajraj NM, Pennant J, Watcha M. Eutectic mixture of local anesthetics (EMLA) cream. Anesth Analg. 1994;78:574–583
  6. Dutta S. Use of eutectic mixture of local anesthetics in children. Indian J Pediatr. 1999;66:707–715
  7. Fetzer S. Reducing venipuncture and intravenous insertion pain with eutectic mixture of local anesthetic. Nurs Res. 2002;51:119–124
  8. Taddio A, Gurguis M, Koren G. Lidocaine-prilocaine cream versus tetracaine gel for procedural pain in children. Ann Pharmacother. 2002;36:687–692
  9. Bucalo B, Mirikitani E, Moy R. Comparison of skin anesthetic effect of liposomal lidocaine, nonliposomal lidocaine, and EMLA using 30-minutes application time. Dermatol Surg. 1998;24:537-451
  10. Peters H, Moli F. Pharmacodynamics of a liposomal preparation of local anesthesia. Arzneimittelforschung. 1995;45:1253–1256
  11. Foldavari M, Gesztes A, Mezei M. Dermal drug delivery by liposome encapsulation: clinical and electron microscopic studies. J Microencapsul. 1990;7:479–489
  12. Wong D. Topical local anesthetics: two products for pain relief during minor procedures. Am J Nurs. 2003;103:42–45
  13. Cook D, Mulrow C, Haynes B. Systematic review: synthesis of best evidence for clinical decisions. Ann Intern Med. 1997;126:376–380
  14. Jadad AR, Cepeda M. Ten challenges at the intersection of clinical research, evidence-based medicine and pain relief. Ann Emerg Med. 2000;36:247–252
  15. Tyler D, Tu A, Douthit J, et al. Toward validation of pain measurement tools for children: a pilot study. Pain. 1993;52:301–309
  16. Ehrenstrom-Reiz G, Reiz S, Stockman O. Topical anaesthesia with EMLA: a new lidocaine-prilocaine cream and the Cusum technique for detection of minimal application time. Acta Anaesthesiol Scand. 1983;27:510–512
  17. Lawson R, Smart N, Gudgeon A, et al. Evaluation of an amethocaine gel preparation for percutaneous analgesia before venous cannulation in children. Br J Anaesth. 1995;75:282–285
  18. Yamamoto LG, Boychuk RB. A blinded, randomized, paired, placebo controlled trial of 20 minute EMLA cream to reduce the pain of peripheral iv cannulation in the ED. Am J Emerg Med. 2003;21:176–179
  19. Ralston SJ, Head-Rapson AG. Use of EMLA cream for skin anaesthesia prior to epidural insertion in labour. Anaesthesia. 1993;48:65–67
  20. Selby I, Bowles B. Analgesia for venous cannulation: a comparison of EMLA lignocaine, ethyl chloride, and nothing. J R Soc Med. 1995;88:264–267
  21. Speirs A, Taylor K, Joanes D, et al. A randomized, double-blind, placebo controlled, comparative study of topical skin analgesics and the anxiety and discomfort associated with venous cannulation. Br Dent J. 2001;190:444–449
  22. Molodecka J, Stenhouse C, Jones JM, et al. A comparison of percutaneous anaesthesia for venous cannulation after topical application of either amethocaine or EMLA cream. Br J Anaesth. 1994;72:174–176
  23. Smith M, Gray B, Ingram S, et al. Double-blind comparison of topical lignocaine-prilocaine cream (EMLA) and lignocaine infiltration for arterial cannulation in adults. Br J Anaesth. 1990;65:240–242
  24. Sharma S, Gajraj N, Sidawi J, et al. EMLA cream effectively reduces the pain of spinal needle insertion. Reg Anesth. 1996;21:561–564
  25. Eichenfield L, Funk A, Fallon-Friedlander S, et al. A clinical study to evaluate the efficacy of ELA-Max as compared with eutectic mixture of local anesthetics cream for pain reduction of venipuncture in children. Pediatrics. 2002;109:1093–1099
  26. Singer A, Richman P, Kowalska A, et al. Comparison of patient and practitioner assessments of pain from commonly performed emergency department procedures. Ann Emerg Med. 1999;33:652–658
  27. Jadad AR, Moore RA, Jenkinson C, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials. 1996;17:1–12
  28. Patterson P, Hussa A, Fedele K, et al. Comparison of 4 analgesic agents for venipuncture. AANA J. 2000;68:43–51
  29. Miller K, Balakrishnan G, Eichbauer G, et al. 1% Lidocaine injection, EMLA cream, or “numby stuff” for topical analgesia associated with peripheral intravenous cannulation. AANA J. 2001;69:185–187
  30. Soliman I, Broadman L, Hannallah R, et al. Comparison of the analgesic effects of EMLA to intradermal lidocaine infiltration prior to venous cannulation in unpremedicated children. Anesthesiology. 1988;68:804–806
  31. Watson A, Szymkiw P, Morgan A. Topical anaesthesia for fistula cannulation in haemodialysis patients. Nephrol Dial Transplant. 1988;3:800–802
  32. Fry C, Aholt D. Local anesthesia prior to the insertion of peripherally inserted central catheters. J Infus Nurs. 2001;24:404–408
  33. Joly L, Spaulding C, Mehran M, et al. Topical lidocaine-prilocaine cream versus local infiltration anesthesia for radial artery cannulation. Anesth Analg. 1998;87:403–406
  34. Giner J, Casan P, Belda J, et al. Utilizacion de la cream anestesica EMLA en la puncion arterial. [Use of the anesthetic cream EMLA in arterial puncture] Rev Esp Anestesiol Reanim. 2000;47:63–66
  35. Elson J, Paech M. EMLA cream prior to insertion of elective epidurals. Anaesth Intensive Care. 1995;23:339–341
  36. Koscielniak-Nielsen Z, Hesselbjerg L, Brushoj J, et al. EMLA patch for spinal puncture: a comparison of EMLA patch with lignocaine infiltration and placebo patch. Anaesthesia. 1998;53:1218–1222
  37. Nilsson A, Boman I, Wallin B, et al. The EMLA patch: a new type of local anesthetic application for dermal analgesia in children. Anaesthesia. 1994;49:70–72
  38. Robieux I, Eliopoulos C, Hwang P, et al. Pain perception and effectiveness of the eutectic mixture of local anesthetics in children undergoing venipuncture. Pediatr Res. 1992;32:520–523
  39. Calamandrei M, Messeri A, Busoni P, et al. Comparison of two application techniques of EMLA and pain assessment in pediatric oncology patients. Reg Anesth. 1996;21:557–560
  40. Chang P, Goresky G, O'Connor G, et al. A multicentre randomized study of single-unit dose package of EMLA patch vs EMLA 5% cream for venipuncture in children. Can J Anesth. 1994;41:59–63
  41. Lander J, Nazarali S, Hodgkins M, et al. Evaluation of a new topical anesthetic agent: a pilot study. Nurs Res. 1996;45:50–53
  42. Kleiber C, Sorenson M, Whiteside K, et al. Topical anesthetics for intravenous insertion in children: a randomized equivalency study. Pediatrics. 2002;110:758–761
  43. Olday S, Walpole R, Wang Y. Radial artery cannulation: topical amethocaine gel versus lidocaine infiltration. Br J Anaesth. 2002;88:580–582
  44. Browne J, Awad I, Plant R, et al. Topical amethocaine (Ametop) is superior to EMLA for intravenous cannulation. Can J Anesth. 1999;46:1014–1018
  45. Romsing J, Henneberg S, Walther-Larsen S, et al. Tetracaine gel vs EMLA cream for percutaneous anaesthesia in children. Br J Anaesth. 1999;82:637–638
  46. Fisher R, Hung O, Mezei M, et al. Topical anaesthesia of intact skin: liposome encapsulated tetracaine vs EMLA. Br J Anaesth. 1998;81:972–973
  47. Hung O, Comeau L, Riley M, et al. Comparative topical anaesthesia of EMLA and liposome-encapsulated tetracaine. Can J Anaesth. 1997;44:707–711
  48. Todd K, Funk K, Funk J, et al. Clinical significance of reported changes in pain severity. Ann Emerg Med. 1996;27:485–489
  49. Kelly AM. Does the clinically significant difference in visual analogue scale pain differ with gender, age or cause of pain?. Acad Emerg Med. 1998;5:1086–1090
  50. Powell C, Kelly A, Williams A. Determining the minimum clinically significant difference in visual analog pain score for children. Ann Emerg Med. 2001;37:28–31

 Supervising editor: Brian H. Rowe, MD, MScAuthor contributions: AE, JW, JL, and DC conceived the study and designed the systematic review. AE and JW designed and implemented the search strategy, acquired relevant articles, and extracted the data. JL provided statistical advice and analyzed the data. AE and DC drafted the manuscript. DC obtained funding. AE takes responsibility for the paper as a whole.Funding and support: Financial support was received from the Evenor Armington and Saltonstall Funds.Presented at the American Academy of Pain Medicine annual meeting, March 2004, Orlando, FL.Reprints not available from the authors.

PII: S0196-0644(05)00133-2

doi: 10.1016/j.annemergmed.2005.01.028

Annals of Emergency Medicine
Volume 46, Issue 4 , Pages 343-351 , October 2005