Does EMLA cream application interfere with the success of venipuncture or venous cannulation? A prospective multicenter observational study

Schreiber, Silvana; Ronfani, Luca; Chiaffoni, Gian Paolo; Matarazzo, Lorenza; Minute, Marta; Panontin, Elisa; Poropat, Federico; Germani, Claudio; Barbi, Egidio

doi:10.1007/s00431-012-1866-6

Cited by 30 publications

(17 citation statements)

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“…It has been proved that applying a local anaesthetic before a needle procedure decreases children's pain and distress and increases the success rate of the procedure (13,(18)(19)(20). Therefore, success at the first attempt is crucial in limiting…”

Section: Discussionmentioning

confidence: 99%

“…Local anaesthetic formulations like EMLA cream containing prilocaine, , which is known to have a vasoconstrictor effect, resulting in epidermal blanching (11). However, after 60 minutes of application, EMLA cream does not cause a significant change in local skin blood flow (12) and it does not interfere with the success rate at the first attempt of venepuncture or intravenous cannulation (13). On the other hand, tetracaine is known to cause local vasodilatation, but the warm patch formulation, together with lidocaine, has a vasodilatatory effect that is less pronounced than other formulations that just contain tetracaine (14).…”

Section: Accepted Articlementioning

confidence: 99%

“…The data available in literature enabled us to estimate that the first-time success rate in children using the EMLA cream would be 85% (13,18). We hypothesized a success rate of 95% for the children using a warm lidocaine and tetracaine patch and by using the Fleiss method with continuity correction, we estimated that 320 subjects -160 for each group -would be needed to carry out the study, with alfa = 0.05 and beta = 0.20.…”

Section: Statistical Analysesmentioning

confidence: 99%

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First‐time success with needle procedures was higher with a warm lidocaine and tetracaine patch than an eutectic mixture of lidocaine and prilocaine cream

et al. 2017

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Accepted ArticleThis article is protected by copyright. All rights reserved. Aim: More than 50% of children report apian during venipuncture 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. Methods:We conducted this multicentre randomised controlled trial at three tertiary-level children's hospitals in Italy in 2015. Children aged 3-10 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. Results: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. Conclusion: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. Accepted ArticleThis article is protected by copyright. All rights reserved.Keywords: eutectic mixture of lidocaine and tetracaine cream; local anaesthetic; needle procedure; procedural success rate; warm lidocaine and tetracaine patch Key notes:• Applying local anesthetics may influence success rates in children undergoing painful needle procedures.• We compared how many needles were inserted at the first attempt when children received a warm lidocaine and tetracaine patch or an eutectic mixture of lidocaine and prilocaine (EMLA) cream.• The three Italian hospitals who took part reported that the success rate was higher in children treated with the warm patch (92.4%) than the cream (85.0%). AbbreviationsARR, absolute risk reduction; CI, confidence intervals; EMLA, eutectic mixture of lidocaine and tetracaine; IQR, interquartile ranges; NNT, number need to treat; RR, relative risks

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Section: Discussionmentioning

confidence: 99%

Section: Accepted Articlementioning

confidence: 99%

Section: Statistical Analysesmentioning

confidence: 99%

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First‐time success with needle procedures was higher with a warm lidocaine and tetracaine patch than an eutectic mixture of lidocaine and prilocaine cream

et al. 2017

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“…A strip squeezed out of the tube that is 1.5 inches×0.2 inches (38 mm×5 mm) is 1 g. On intact non-mucosal skin, depth of anaesthesia reaches 3 mm after 60 min and 5 mm after 120 min. Although EMLA produces vasoconstriction and blanching, it does not decrease vein catheterisation success 2. The prilocaine component of EMLA increases the risk of the rare adverse effect methemoglobinemia.…”

Section: Topical Anaesthetics For Intact Skinmentioning

confidence: 99%

Topical anaesthetics: What's new?

Young

2014

Arch Dis Child Educ Pract Ed

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Topical anaesthetics, often used by anaesthetists, dentists and dermatologists, have increasingly been recognised for their utility in paediatrics. With topical anaesthetics, the 'ouchless' paediatric practice becomes an achievable goal. The primary drawback to their use is the length of time for anaesthetic effect, but planning ahead and making use of newer formulations and adjuncts can overcome this barrier. This update will review topical anaesthetic formulations available, adjuncts to reduce the time to anaesthesia, adverse effects, common indications and products on the horizon.

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“…However, there seems to be some developmental research for lidocaine microneedles. Recently, the 3M group developed a lidocaine solution mixed with Dextran to uniformly coat medical-grade, liquid crystalline polymer (class VI) for pre-clinical in vivo studies using biopsy porcine skin of live pigs resulting in successful delivery of lidocaine at a faster time compared to eutectic mixture of local anaesthetics (EMLA) composed of lidocaine and prilocaine as a combined eutectic formulation Schreiber et al 2013). A less recent but highly significant development was made by Theraject, Inc (Kwon.…”

Section: Introductionmentioning

confidence: 99%

Potential of biodegradable microneedles as a transdermal delivery vehicle for lidocaine

Nayak

Das

2013

Biotechnol Lett

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There has been an increasing interest in applying biotechnology in formulating and characterising new and innovative drug delivery methods, e.g., drug-loaded biodegradable microneedles within the area of transdermal delivery technology. Recently, microneedles have been proposed for use in pain management, e.g., post-operative pain management through delivery of a local anaesthetic, namely, lidocaine. Lidocaine is a fairly common, marketed prescription-based local anaesthetic pharmaceutical, applied for relieving localised pain and lidocaine-loaded microneedles have been explored. The purpose of this review is to evaluate the properties of biodegradable polymers that may allow the preparation of microneedle systems, methods of preparing them and pharmacokinetic conditions in considering the potential use of lidocaine for delivery through the skin.

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Does EMLA cream application interfere with the success of venipuncture or venous cannulation? A prospective multicenter observational study

Abstract: In this study, EMLA use did not interfere with the success of venipuncture or venous cannulation in children.

Cited by 30 publications

References 9 publications

First‐time success with needle procedures was higher with a warm lidocaine and tetracaine patch than an eutectic mixture of lidocaine and prilocaine cream

First‐time success with needle procedures was higher with a warm lidocaine and tetracaine patch than an eutectic mixture of lidocaine and prilocaine cream

Topical anaesthetics: What's new?

Potential of biodegradable microneedles as a transdermal delivery vehicle for lidocaine

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