Use of EMLA® cream in a Department of Neonatology

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

doi:10.1016/s0304-3959(96)03208-3

Cited by 31 publications

(11 citation statements)

References 11 publications

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“…[27][28][29] This may be due to the use of small doses 28,29 short duration of application 2 8 and absence of other risk factors (e.g., first few days of life in patients less than 32 weeks of gestational age, anemia and the concomitant administration of paracetamol) for methemoglobinemia. 28,29 While paracetamol administration and anemia were common in our patients, clinical signs of methemoglobinemia were not observed (methemoglobin levels were not measured). However, our youngest patient was 36 weeks postconceptional age and only single small doses of EMLA® were applied.…”

Section: Discussionmentioning

confidence: 99%

Spinal anesthesia in 62 premature, former-premature or young infants-technical aspects and pitfalls

Shenkman

Hoppenstein

Litmanowitz

et al. 2002

Can J Anesth/J Can Anesth

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Methods:The medical history and perioperative course of all infants who underwent SA over a 28-month period were collected (retrospectively in the first 20).Results: Sixty-two infants underwent surgery under SA. Fifty-five were premature and former-premature, postconceptional age 43.3 ± 5.0 weeks, weight 3261 ± 1243 g. Of these, 21 had co-existing disease: cerebral (six), cardiac (nine), pulmonary (11) and urological (six). Hyperbaric tetracaine or bupivacaine 1 mg·kg -1 with adrenaline was administered. Four infants (three premature) required N 2 O supplementation and three needed general anesthesia. The supplementation rate was similar or lower than in previous studies. Postoperatively, all seven were shown to have lower limb motor and sensory blockade. Complications in premature patients included intraoperative hypoxemia (two), apnea (two) and bradycardia (one). Postoperative complications included bradycardia (three), hypoxemia (one) and apnea and hypoxemia (one). The postoperative complication rate was similar to previous studies.Conclusion: Successful SA in infants depends on close attention to preoperative assessment, appropriate patient positioning during and after lumbar puncture, drug dosing and intra-and postoperative cardiorespiratory monitoring. A relatively high dose of hyperbaric solution of tetracaine or bupivacaine with adrenaline should be administered.

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Section: Discussionmentioning

confidence: 99%

Spinal anesthesia in 62 premature, former-premature or young infants-technical aspects and pitfalls

Shenkman

Hoppenstein

Litmanowitz

et al. 2002

Can J Anesth/J Can Anesth

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“…During a 2-year study period, Gourrier and colleagues 25,26 administered a mean of 3.2 doses of EMLA to 500 infants (GA, 26 to 41 weeks; postnatal age, Յ3 months). One hundred fifty-eight follow-up MetHb concentrations were obtained.…”

Section: Safety Studiesmentioning

confidence: 99%

“…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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“…Nach einer Einwirkzeit von 60 min führt EMLA in Dosierungen von 0,5-2,0 g Der Schmerz 5•2000 | 327 zur präinterventionellen Analgesie zu einer signifikanten Schmerzreduktion bei Hautperforationen mittels venöser und arterieller Kanülen, bei Anlage perkutaner Katheter, bei Shuntpunktion bei Dialysepatienten und bei Lumbalpunktionen [4,14,16,19,29,35,52,66].…”

Section: Schleimhaut-und Perkutane Anästhesieunclassified

“…Gestationswoche sicher und effektiv [18,19,65,66]; selbst Repetitionsdosen im 8-h-Abstand sind erlaubt [55]. In Deutschland ist EMLA für Neonaten ab der 37.…”

Section: Schleimhaut-und Perkutane Anästhesieunclassified