Problèmes cutanés après application d'EMLA® chez des prématurés

Gourrier, E; Hansche, A. El; Karoubi, Philippe; Mouchnino, G; Merbouche, S.; Leraillez, J

doi:10.1016/0929-693x(96)81314-5

Cited by 16 publications

(12 citation statements)

References 3 publications

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“…Gourrier et al 16 encountered erythema in 3% (3/116) of neonates because of the occlusive (Tegaderm, 3M, Minneapolis, MN) dressing. After 2 years of clinical use of EMLA, Gourrier et al 25,29 reported the occurrence of purpuric lesions on the site of application in 5 instances. Four neonates Ͻ32 weeks gestation and Ͻ3-days postnatal age experienced five episodes of rash (1 neonate had a second reaction when exposed to EMLA at a different skin site) after receiving doses of one eighth to one sixth of a 5 g tube of EMLA for 90 to 120 minutes.…”

Section: Safety Studiesmentioning

confidence: 99%

A Systematic Review of Lidocaine-Prilocaine Cream (EMLA) in the Treatment of Acute Pain in Neonates

et al. 1998

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ABSTRACT. Objective. Neonates routinely undergo painful cutaneous procedures as part of their medical treatment. Lidocaine-prilocaine 5% cream (EMLA) is a topical anesthetic that may be useful for diminishing the pain from these procedures. EMLA is routinely used in children and adults. There is substantial apprehension about its use in neonates because of concerns that it may cause methemoglobinemia. The objective of this review was to determine the efficacy and safety of EMLA as an analgesic for procedural pain treatment in neonates and provide evidence-based recommendations for clinical practice.Methods. Systematic review techniques were used. Studies were identified using manual and computeraided searches (Medline, EMBASE, Reference Update, personal files, scientific meeting proceedings). Behavioral (eg, facial action, crying) and physiologic (eg, heart rate, oxygen saturation, blood pressure, respiratory rate) outcome data from prospective nonrandomized controlled studies and randomized controlled trials in fullterm and preterm neonates were accepted for inclusion to establish efficacy of EMLA. The risk of methemoglobinemia (defined as methemoglobin concentration >5% and requiring medical intervention) was estimated from all prospective studies.Results. Eleven studies of the efficacy of EMLA were included in the analysis. Infant gestational age at the time of delivery ranged from 26 weeks to full-term. Two studies included data from both neonates and older infants. The following procedures were studied: circumcision (n ‫؍‬ 3), heel lancing (n ‫؍‬ 4), venipuncture (n ‫؍‬ 1), venipuncture and arterial puncture (n ‫؍‬ 1), lumbar puncture (n ‫؍‬ 1), and percutaneous venous catheter placement (n ‫؍‬ 1). Nine studies were randomized controlled trials. The total sample size for each study ranged from 13 to 110 neonates. The dose of EMLA used was 0.5 g to 2 g in 9 studies, and was not specified in the others. The duration of application ranged from 10 minutes to 3 hours. The three studies that investigated the efficacy of EMLA for decreasing the pain of circumcision used a randomized controlled trial design. All of them demonstrated significantly reduced crying time during the procedure in the infants in the EMLA group compared with the infants in the control group. Facial grimacing, assessed in two of the studies, was also significantly lower in the EMLA group. Using meta-analytic techniques, the heart rate outcome data for two studies was summarized. Increases in heart rate compared with baseline values were 12 to 27 beats per minute less for the EMLA group than in the placebo group during various stages of the surgical procedure. Three studies that investigated the pain from heel lancing were randomized controlled trials; the other was a nonrandomized controlled study. None demonstrated a significant benefit of EMLA for any of the outcome measures used to assess pain (ie, behavioral pain scores, infant crying, heart rate, blood pressure, respiratory rate, oxygenation parameters). One randomized controlled study ...

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Section: Safety Studiesmentioning

confidence: 99%

A Systematic Review of Lidocaine-Prilocaine Cream (EMLA) in the Treatment of Acute Pain in Neonates

et al. 1998

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“…Iontophoresis of various anesthetic agents including lidocaine has also been used to administer transdermal anesthesia. Used appropriately, these methods of anesthesia may reduce or obviate the pain and discomfort of certain procedures (Table 1) 1–15 . Topical anesthetics and iontophoresis are discussed in detail by other authors in this issue (see Friedman PM, et al and Greenbaum SS).…”

Section: Topical Anestheticsmentioning

confidence: 99%

“…There is a report of extensive corneal deepithelialization with direct exposure of the cornea to EMLA, though without permanent sequelae 5 . Purpura and petechiae have developed with the application of as little as 1 g of EMLA for as short a time as 30 minutes in children and adults 6–10,16 . Complete resolution of this phenomenon was seen over several days.…”

Section: Topical Anestheticsmentioning

confidence: 99%

“…Used appropriately, these methods of anesthesia may reduce or obviate the pain and discomfort of certain procedures ( Table 1). [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Topical anesthetics and iontophoresis are discussed in detail by other authors in this issue (see Friedman PM, et al and Greenbaum SS).…”

Section: Topical Anestheticsmentioning

confidence: 99%

“…5 Purpura and petechiae have developed with the application of as little as 1 g of EMLA for as short a time as 30 minutes in children and adults. [6][7][8][9][10]16 Complete resolution of this phenomenon was seen over several days. Purpura may be more common in premature infants and in patients with atopic dermatitis.…”

Section: Safety Complications and Limitations In The Use Of Emlamentioning

confidence: 99%

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