Sharp wound debridement in local anaesthesia using EMLA cream: 6 years?? experience in 1084 patients

Abstract

Sharp debridement is the most efficient method for clearing the woundbed in the exudation and granulation phase of wound healing. At our clinic the anaesthetic lidocaine-prilocaine cream, EMLA, has been used as an analgesic for sharp debridement since 1994. A review of patients' records was conducted, including ulcer size, dose of cream used, analgesic efficacy and complications. During a 6-year period a total of 1084 patients were treated for leg ulcers, decubitus ulcers, abscess revisions, anal and coccyx fistulae, postoperative wounds, diabetic ulcers and burns. Doses ranging from 3 to 150 g cream were applied for 45-60 min. In all patients except three the analgesia was adequate for debridement. We observed no allergic reactions, no clinical symptoms of local anaesthetic toxicity or methaemoglobinaemia. In 12 patients (1.1%) a burning sensation was reported directly after the application of EMLA cream to the ulcer, which, however, subsided within 15-20 min. In our experience, sharp debridement in percutaneous analgesia with EMLA is efficient, economical, safe, and tolerable for the patient.

Review of Lidocaine/Tetracaine Cream as a Topical Anesthetic for Dermatologic Laser Procedures

“…Both of these topical treatment options are effective at relieving pain, but they require lengthy application times and occlusion, and may provide inadequate anesthesia at peripheral skin margins [11, 12]. EMLA cream has proven to have anesthetic efficacy in several clinical trials involving such dermatologic procedures as cryotherapy, pulsed dye laser treatment, and debridement of leg ulcers [13–16]. …”

“…Analgesia is achieved to a depth of 3 mm after 60 min and a maximum depth of 5 mm after 120 min of EMLA exposure [5]. As such, EMLA has been shown to provide effective anesthesia for several different procedures, but requires occlusion and does not provide adequate anesthesia at peripheral skin margins [1, 13–16]. …”

The Lidocaine/Tetracaine Peel: A Novel Topical Anesthetic for Dermatologic Procedures in Adult Patients

“…The most widely used topical agent for anesthetizing intact skin is a eutectic mixture of local anesthetics (EMLA) cream composed of 2.5% lidocaine and 2.5% prilocaine in an oil‐in‐water emulsion 1 . The anesthetic efficacy of EMLA cream has been proven in numerous clinical trials for a variety of cutaneous procedures, including cryotherapy, 2 pulsed dye laser (PDL) treatment, 3 and debridement of venous leg ulcers 4,5 . There are several drawbacks to using EMLA cream, however, including the need for occlusion, inadequate anesthesia at the peripheral skin margins, 6 and the potential for eye injury when used in the periocular region 7 …”

Comparison of topical lidocaine/prilocaine anesthetic cream and local infiltration of 2% lidocaine for episioplasty in mares

“…, 1990; Hansson et al. , 1993; Blanke & von Hallern, 2003) and may actually be beneficial for the healing of sterile surgical wounds, as topical anesthetics have been shown to have antimicrobial activity (Schmidt & Rosenkranz, 1970; Wimberley et al. , 1979).…”