A blinded, randomized, paired, placebo-controlled trial of 20-minute EMLA cream to reduce the pain of peripheral IV cannulation in the ED

A eutectic mixture of local anesthetics (EMLA) in cream from has been used as a topical anesthetic to reduce the pain of procedures penetrating the skin. It is generally applied for 45 to 60 minutes before the painful procedure. The purpose of this study was to determine whether a 20-minute application of EMLA is useful in reducing the pain of routine peripheral intravenous cannulation in the emergency department (ED). A blinded, randomized, placebo-controlled, paired trial compared the pain of intravenous cannulation in both hands of study subjects: one hand was treated with 20-minute EMLA cream and the other hand was treated with 20-minute placebo cream. Forty subjects identified the more painful hand and scored pain measurements of each hand using a 10-cm visual analog scale. These data failed to demonstrate any significant benefit of EMLA compared with placebo. EMLA is not useful for intravenous cannulation when used for 20-minute application times. There may be more effective and less costly ways of reducing the pain of intravenous cannulation that patients would prefer.     

复方利多卡因乳膏表面麻醉在无痛分娩中的应用

目的观察复方利多卡因乳膏应用于无痛分娩的临床效果及安全性。方法将100例住院分娩的足月初产妇分为观察组及对照组各50例。对照组采用0.15%罗哌卡因+1～2μg/ml芬太尼行硬膜外分娩镇痛;观察组在实施硬膜外镇痛的同时进行宫颈复方利多卡因乳膏表面麻醉。观察两组的疼痛程度、产程时间、难产率、产后出血量及新生儿窒息率。结果观察组的疼痛程度明显轻于对照组(P<0.05),其产程时间、难产率、产后出血量及新生儿窒息率亦明显低于对照组(P<0.05)。结论复方了利多卡因乳膏表面麻醉能明显增强无痛分娩镇痛效果,提高无痛分娩的安全性。     

EMLA膏剂对儿科常见有创操作的镇痛作用研究

目的 :探讨EMLA膏剂对儿科常见有创操作的镇痛作用和可行性。方法 :应用便利抽样的方法 ,抽取 4岁以上的患儿 10 0例 ,采用Wong -Baker和FLACC量表对未涂用EMLA和涂于穿刺部位 1h后进行有创操作的主、客观疼痛评分。结果 :EMLA膏剂明显降低各项有创操作的主观、客观疼痛评分 (P <0 .0 0 1) ,学龄期患儿用EMLA后的主、客观疼痛评分显著低于学龄前期的患儿 (P <0 .0 1)。结论 :EMLA可有效减轻有创操作的疼痛反应     

Application of topical analgesia in triage: a potential for harm

To reduce the overall time spent in the ED, triage nurses are encouraged to treat patients with a topical anesthetic cream, eutectic mixture of local anesthetics (EMLA). We present a case in which a 28-day-old neonate who was treated with EMLA cream in triage developed severe methemoglobinemia 18 hours post admission to the pediatric ward. This case demonstrates that there may be some risks associated with this approach, and that protocols for the use of EMLA at triage should include not only the indications for its use, but also need to ensure that there is a process to have the EMLA removed before patient discharge or transfer.     

恩纳用于小儿气管异物取出术的临床观察

目的 :小儿气管异物取出术常因小儿不能耐受支气管镜而出现不同程度的屏气和缺氧。本研究目的在于观察恩纳 (EMLACream ,EC)用于小儿气管异物取出术的有效性和安全性 ,以及是否能降低术中小儿屏气和缺氧的发生率及程度。方法 :30名患气管异物的小儿随机分为恩纳组和对照组。恩纳组在支气管镜表面均匀涂抹EC 0 2～ 0 3g。术中记录患儿屏气程度、最低SpO2 的值及追加氯胺酮的例数。术后手术医生对麻醉满意度评分。结果 :恩纳组患儿的屏气程度明显轻于对照组 ,中度以上屏气恩纳组有 4人 (2 6 7% ) ,对照组有 1 1人(73 3% ) (P <0 0 5 )。术中最低SpO2 恩纳组 (93%± 5 % )明显高于对组 (83%± 1 2 % ) ,(P =0 0 1 2 ) ,其中对照组SpO2 最低降至 5 4 % ,而恩纳组最低降至 83%。术中追加氯胺酮的例数恩纳组明显少于对照组 (3人vs1 1人 )(P <0 0 5 )。术后手术医生对麻醉的满意度评分恩纳组 (90 4± 8 8)明显高于对照组 (79 7± 1 3) (P =0 0 2 1 )。结论 :本研究表明 ,EC可安全有效地用于小儿气管异物取出术 ,能明显降低术中小儿屏气和缺氧的发生率及程度 ,减少麻醉药用量     

Successful treatment of a keratoacanthoma in a young patient with the application of topical 5% imiquimod cream

Keratoacanthomas (KA) are epithelial tumors that present as rapidly evolving nodules with a central hyperkeratotic plug and occasionally show signs of spontaneous regression. A 21‐year‐old patient strongly refused the diagnostic biopsy and insisted on a nonsurgical treatment. He was successfully treated with imiquimod 5% cream.     

序贯外用地奈德乳膏与克立硼罗软膏治疗轻中度特应性皮炎的疗效和安全性

目的 探讨序贯外用0.05%地奈德乳膏与2%克立硼罗软膏治疗轻中度特应性皮炎（atopic dermatitis,AD的疗效、安全性及复发率。方法 选取2021年7月至2022年8月南通大学附属医院皮肤科门诊轻至中度AD患者179例，随机分为3组：序贯治疗组外用0.05%地奈德乳膏连续治疗2周后，换用2%克立硼罗软膏，继续治疗2周；地奈德组外用0.05%地奈德乳膏连续治疗2周，接着每周2次再治疗2周；克立硼罗组外用2%克立硼罗软膏连续治疗4周。比较3组患者治疗前后的特应性皮炎评分（scoring atopic dermatitis, SCORAD）、治疗后的临床疗效、不良反应发生率及随访停药4周后的复发率。结果 序贯治疗组治疗后的SCORAD评分为（6.69±6.31）分、有效率为82.5%，与地奈德组[（5.39±4.25）分，87.5%]比较，差异无统计学意义；与克立硼罗组[（11.25±8.82）分，54.7%]比较，差异有统计学意义（P=0.002）。序贯治疗组、地奈德组和克立硼罗组患者的复发率和不良反应发生率分别为12.8%、31.0%、13.8%和8.8%、22.9%、9....     

盐酸特比萘酚乳膏和硝酸咪康唑乳膏治疗皮肤癣菌感染的临床疗效比较

目的探讨盐酸特比萘芬乳膏和硝酸咪康唑乳膏治疗皮肤癣菌感染的临床疗效。方法选择该院2011年6月至2013年6月收治的200例皮肤癣菌感染患者,随机分为试验组和对照组,每组各100例。试验组患者使用盐酸特比萘酚乳膏涂抹于患处,每天2次,早晚各1次;对照组患者使用硝酸咪康唑乳膏涂抹患处,每天1次。手癣、体股癣及严重者的治疗疗程分别为2、4、6周。疗程结束后,对两组患者的临床疗效进行比较。结果试验组患者的临床有效率(90.62%)和痊愈率(83.12%)明显高于对照组患者(78.25%和63.25%),差异有统计学意义(P0.05)。结论盐酸特比萘酚乳膏治疗皮肤癣菌感染疗效优于硝酸咪康唑乳膏,安全性好。     

Ultrasound Guidance versus the Landmark Technique for the Placement of Central Venous Catheters in the Emergency Department

OBJECTIVE: To compare ultrasound (US)-guided vs. landmark-guided techniques for central venous access (CVA) in the emergency department. METHODS: This was a prospective study of consecutive patients enrolled at a university teaching hospital with an annual census of approximately 100,000. On even days patients had CVA with ultrasonic assistance; patients presenting on odd days had CVA via traditional landmark techniques. Ultrasound users were emergency medicine faculty or residents who completed a one-hour training session. A data collection tool with 17 variables was completed for each central line placed. Variables were compared using the independent t-test, Fisher's exact test, and the non-parametric Mann-Whitney U test. RESULTS: Between August 1, 2000, and February 1, 2001, data for 122 subjects (n = 51 for US, and n = 71 for landmark) were collected. Variables with statistically significant differences are as follows. Mean (+/-SD) time from skin puncture to blood flash was 115 (+/-184) seconds for the US group vs. 512 (+/-698) seconds for the landmark group (p < 0.0001). The mean number of CVA attempts in the US group was 1.6 (+/-1.0) vs. 3.5 (+/-2.7) in the landmark group (p < 0.0001). Acute complications were comparable between groups. Comparisons for time, number of CVA attempts, and complications were done specifically for a subset of patients considered to be "difficult stick" due to predefined criteria regarding body habitus or vascular disease. Patients considered to be "difficult sticks" required a significantly longer amount of time (p < 0.001) for CVA via the landmark technique than patients considered to be "difficult sticks" who had CVA with ultrasonic guidance. Time to line placement for the landmark group was 462.7 (+/-627) seconds vs. 93.3 (+/-176) seconds in the US group. Comparing the same subset also revealed an increase in number of required CVA attempts for the landmark technique group. The number of acute complications in the "difficult stick" patients did not show statistical significance (p = 1.00). The landmark group had 60% "difficult sticks," while the ultrasound group had 80%, although the difference was not statistically significant (p = 0.08). CONCLUSIONS: Emergency physicians with limited training and experience are able to use ultrasound as an adjunct for central venous access. Ultrasound technology may decrease the number of CVA attempts required to cannulate a central vein and will decrease the amount of time required to cannulate the vein starting from the time when the needle is on the skin, after the ultrasound machine has been set up and turned on. These results are especially true for those patients considered to be "difficult sticks."     

Evaluation of analgesic protocol with nitrous oxide and EMLA cream during botulinum toxin injections in children]

AIMS: To evaluate the efficiency and tolerance of analgesic treatment with nitrous oxide and topical eutectic mixture of local anesthetics (EMLA) in children undergoing botulinum toxin injections for focal spasticity. METHODS: Prospective study including 40 consecutive patients aged 2 to 17 years, most with cerebral palsy, undergoing botulinum toxin injections. Ten had severe cerebral palsy with cognitive deficiency. For most patients the treatment involved several muscles, with several injections per muscle. The total number of injections varied from 1 to 25. The procedure was performed with topical anesthesia with EMLA and inhalation of nitrous oxide (50% nitrous oxide, 50% oxygen). Reactions were recorded by the staff (a practician, a nurse, an auxiliary staff member and an internist) and whether they related to the injection or were nonspecific. RESULTS: A total of 45% of patients showed no clinical manifestation of pain; for 30%, reactions were crying and withdrawal directly related to the injections; and for 25%, manifestations seemed nonspecific and mainly related to overall anxiety and discomfort. In 3 patients, moderate side effects were observed (visual hallucinations and euphoria). DISCUSSION: Nitrous oxide analgesic with topical EMLA was efficient for children undergoing botulinum toxin injections but remained insufficient for half of our patients, and modification of the protocol is needed in some cases. Precise evaluation of acute pain is difficult in children with major cognitive deficits. Clinical manifestations are related to pain but also to overall anxiety and stress.     

依巴斯汀片联合重组牛碱性成纤维细胞生长因子凝胶及舒敏保湿特护霜治疗老年患者面部激素依赖性皮炎的临床效果

目的探讨依巴斯汀片联合重组牛碱性成纤维细胞生长因子凝胶及舒敏保湿特护霜治疗老年患者面部激素依赖性皮炎的临床效果。方法将60例老年面部激素依赖性皮炎患者随机分为对照组(外用生理盐水)、观察1组(外用重组牛碱性成纤维细胞生长因子凝胶)、观察2组(在观察1组基础上外用舒敏保湿特护霜),各20例,三组均口服盐酸依巴斯汀片。比较三组的治疗效果。结果观察2组的治疗起效时间短于对照组及观察1组(P<0.05)。治疗1周和1个月后,观察1组与观察2组的自觉症状和客观体征评分均低于对照组,且观察2组低于观察1组(P<0.05)。观察1组与观察2组的治疗总有效率无显著差异(P>0.05),但均高于对照组(P<0.05)。药物不良反应发生例数较少,为一过性,均不影响治疗。观察1组与观察2组的复发率无显著差异(P>0.05),但均低于对照组(P<0.05)。结论依巴斯汀片联合重组牛碱性成纤维细胞生长因子凝胶及舒敏保湿特护霜治疗老年患者面部激素依赖性皮炎安全有效,值得在临床推广。     

Comparison of cooling and EMLA to reduce the burning pain during capsaicin 8% patch application: A randomized,double-blind,placebo-controlled study

Topical capsaicin 8% was developed for the treatment of peripheral neuropathic pain. The pain reduction is associated with a reversible reduction of epidermal nerve fiber density (ENFD). During its application, topical capsaicin 8% provokes distinct pain. In a randomized, double-blind study analyzed with a block factorial analysis of variance, we tested whether cooling the skin would result in reliable prevention of the application pain without inhibiting reduction of ENFD. A capsaicin 8% patch was cut into 4 quarters and 2 each were applied for 1 hour on the anterior thighs of 12 healthy volunteers. A randomization scheme provided for 1 of the application sites of each thigh to be pretreated with EMLA and the other with placebo, whereas both application sites of 1 thigh, also randomly selected, were cooled by cool packs, resulting in a site temperature of 20°C during the entire treatment period. The maximum pain level given for the cooled sites (visual analogue scale [VAS] 1.3 ± 1.4) proved to be significantly lower than for the non-cooled sites (VAS 7.5 ± 1.9) (P < .0001). In contrast, there was no significant difference in application pain between the sites pretreated with EMLA or with placebo (VAS 4.1 ± 3.6 vs 4.8 ± 3.5, P = .1084). At all application sites, ENFD was significantly reduced by 8.0 ± 2.8 (ENF/mm ± SD, P < .0001), that is, 70%, with no significant differences between the sites with the different experimental conditions. In conclusion, cooling the skin to 20°C reliably prevents the pain from capsaicin 8% patch application, whereas EMLA does not. ENFD reduction is not inhibited by cooling.     

A randomized comparison of ketorolac tromethamine and morphine for postoperative analgesia in critically ill children

OBJECTIVES: To evaluate the efficacy of a single dose of ketorolac compared with morphine for the relief of pain in children, and to determine the safety of ketorolac. SETTING: Tertiary pediatric intensive care unit in a university-affiliated hospital. DESIGN: Prospective, randomized, double-blind, parallel, single-dose, positive control study. PATIENTS: Children admitted to the intensive care unit with postoperative pain. INTERVENTIONS: Patients received a single dose of either morphine or ketorolac as the first postoperative analgesic when the pain score indicated significant pain. Blood pressure, heart rate, and urine output were recorded, as well as blood urea nitrogen, creatinine, bleeding time, hematuria or proteinuria, and aspartate aminotransferase. Side effects such as nausea and vomiting were noted. Morphine was used for rescue treatment if the patient continued to have significant pain > or =30 mins after study drug administration. MEASUREMENTS AND MAIN RESULTS: Of the 102 children studied, 48 received morphine and 54 received ketorolac. The percentage of patients reporting pain relief in the first and second hours after drug administration was not different between groups. Likewise, the proportion of patients who met the criteria for pain relief during the entire evaluation period was not different between groups. There was a trend toward fewer patients who received ketorolac requiring remedication in the first 4 hrs compared with those who received morphine, but this trend did not reach statistical significance. More patients in the morphine group failed to achieve pain relief at any time after the dose compared with those who received ketorolac. There were no differences between the two groups in physiologic or laboratory variables. Vomiting was more common in patients who received ketorolac. CONCLUSION: Ketorolac is comparable to morphine in relief of postoperative pain in children. A single dose of ketorolac does not result in abnormal postoperative bleeding or alter renal function. However, ketorolac may cause nausea and vomiting in some patients.     

多磺酸粘多糖乳膏外用与湿热敷法预防肿瘤患者PICC置管后静脉炎的效果比较

目的探讨多磺酸粘多糖乳膏外用与湿热敷法两种干预措施对肿瘤患者PICC置管后静脉炎的效果。方法选取首次进行PICC置管的患者396例,分为多磺酸粘多糖乳膏外用组196例和湿热敷组200例,给予两组患者相同的健康教育,比较两组患者静脉炎的发生率以及静脉炎的严重程度。结果两组患者静脉炎发生率及严重程度比较差异均无统计学意义(P0.05)。结论多磺酸粘多糖乳膏外用与湿热敷法均可用于预防肿瘤患者PICC置管后静脉炎,临床中可根据患者经济状况及舒适需求自主选择。     

Treatment of chronic ulcers in the lower extremities with topical becaplermin gel .01%: A multicenter open-label study

This prospective, multicenter, open-label study assessed the efficacy and tolerability of recombinant human platelet-derived growth factor BB (becaplermin) in the treatment of chronic ulcers of the lower extremities in 73 patients with and without type 2 diabetes mellitus. Becaplermin gel .01% was applied once daily for 12 weeks. Efficacy was assessed in terms of progression to healing (100% epithelialization); the secondary efficacy endpoint was time to complete healing. Safety was assessed in terms of incidence of adverse events. Ninety-five percent of all ulcers were completely healed at week 9; only 5% remained incompletely healed at week 12 and were considered treatment failures. Healing time did not differ between diabetic and nondiabetic patients. The major adverse events were pain, burning sensation, and pruritus at the ulcer site, with an overall incidence of 10%. No patients dropped out because of adverse events. Becaplermin gel .01 % was safe and well tolerated. Further studies are necessary to assess the durability of healing with this treatment.