Evaluation of eutectic lidocaine/prilocaine cream for jugular blood sampling in cats

Abstract

Objectives The study aimed to evaluate the efficacy of a eutectic lidocaine/prilocaine cream (EMLA cream; Astra Pharmaceuticals) in reducing pain and reaction to venepuncture during jugular blood sampling in cats after a 30-min topical application time. Methods The study was a prospective, blind, controlled clinical trial. Eighteen healthy client-owned cats were randomly allocated to two study groups. All cats were clipped on the left jugular groove region and then, depending on the study group, either the placebo (liquid paraffin) or EMLA cream was applied to the region. The area was then kept protected for the next 30 mins. Except for the operator who administered the product, all operators were blinded to the study groups. Blood sampling was performed by an experienced operator and a stress score was assigned to each cat according to the reactions observed during the venepuncture. Also, the procedure was classified as being ‘easy’ or ‘difficult’ by the same operator. Results A significantly reduced stress score was observed in cats that received the EMLA cream compared with those belonging to the placebo group ( P = 0.048); withdrawal movements were observed in 1/9 cats treated with the EMLA cream vs 7/9 cats of the placebo group ( P = 0.015). The jugular venepuncture was defined as easy in 1/9 cats that received the placebo and in 8/9 cats in the EMLA group ( P = 0.015). Conclusions and relevance The present study provides evidence for the efficacy of the EMLA cream after a 30-min application time for jugular venepuncture in cats, together with significantly reduced stress for patients. Therefore, this study supports the routine use of EMLA cream as good practice to enhance the welfare of cats and to simplify venepuncture procedures.

A Review on Mitigating Fear and Aggression in Dogs and Cats in a Veterinary Setting

“…A possible explanation for the longer application period necessary to achieve a sufficient analgesic effect in dogs compared to cats might lie in differences relating to the skin, but also behavioural species differences. Furthermore, stress-induced peripheral vasoconstriction could influence the effectiveness of topical analgesics [ 82 ].…”

Efficacy of EMLA™ cream for reducing pain associated with venepuncture in felines

“…The application of Eutectic Mixture of Local Anaesthetics (EMLA™) cream to clipped skin over the procedure site, a minimum of 30 minutes prior to the venepuncture procedure, significantly reduced the severity of pain-associated behaviours during jugular phlebotomy in healthy, conscious feline patients when compared to a placebo 1,2 . In felines sedated with dexmedetomidine and either methadone or nalbuphine, the administration of EMLA™ cream to clipped skin for 20 minutes significantly decreased the severity of pain responses during intravenous (IV) cephalic vein catheterisation when compared to no treatment 3 .…”

“…The NRS used by Wagner et al 4 and Crisi et al 1 was adapted from the Modified Behavioural Pain Scale (MBPS) 10,24 . This was originally developed by paediatric clinicians to evaluate postoperative pain 24 and was later used to assess pain during venepuncture in children 25,26 .…”

“…In cats, age has been implicated as a factor that may influence the behavioural expression of pain 18 . The study designs by Crisi et al 1 and Oliveira et al 3 attempted to control this confounder by evidencing that age did not differ significantly between the randomised treatment groups. In comparison, Wagner et al 4 and Flecknell et al 2 failed to demonstrate the absence, or presence, of any significant difference in age between treatment groups by way of statistical analysis.…”

“…However, such a design has its own limitations with regard to minimising other confounding factors in between procedures 31 , and would have decreased the degree of study design refinement. In all studies, except Crisi et al 1 , patients were only enrolled if they had a non-related indication for venepuncture, which would be much more challenging to achieve for a paired analysis design, potentially generating exclusion bias 30 .…”