Efficacy of a topical anesthetic on pain and unpleasantness during scaling of gingival pockets.

The efficacy of a topical anesthetic on pain and unpleasantness provoked by scaling of gingival pockets was investigated in 20 patients with mild chronic periodontitis. A eutectic mixture of local anesthetics (EMLA) and a placebo cream, both occluded by Orahesive Oral Bandages, were applied in a balanced, randomized, double-blind, split-mouth design, which enabled within-subject comparison of the anesthetic and the placebo in the upper and the lower jaw. Pretreatment interviews showed that approximately two-thirds of the patients considered gingival scaling to be associated with some degree of pain and unpleasantness. Pain intensity and unpleasantness were evaluated on 100-mm visual analog scales (VAS). Application of EMLA reduced both pain intensity and unpleasantness significantly compared to placebo cream. Median reductions in VAS pain intensity in the upper and lower jaw were 58.9% and 61.9%, and corresponding reductions in VAS unpleasantness were 31.9% and 25.6%, respectively. Generally, the patients accepted the anesthetic procedure well. The residual perception of pain and unpleasantness following topical anesthesia may be dependent on activation of nonanesthetized nociceptive fibers in the tooth pulp. However, the present study clearly demonstrates the efficacy of a topical anesthetic in a clinical situation, which may be recommended as a simple pharmacologic strategy to reduce pain and unpleasantness during scaling procedures.     

EMLA cream prior to digital nerve block for ingrown nail surgery does not reduce pain at injection of anesthetic solution

BACKGROUND: Needle penetration and local anesthetic infiltration are painful steps of digital ring block. The objective of this study was to evaluate the efficacy of EMLA cream application prior to digital ring block for surgery for ingrown big toenail. METHODS: We conducted a prospective, double-blinded, placebo-controlled, randomized clinical trial with 81 patients (range: 12-75 years, mean +/- SD: 30.3 +/- 17.5 years), who underwent big toenail surgery. Prior to the digital block, EMLA cream (Group E) or a placebo cream (Group P) was applied. A visual analog scale (VAS) and a verbal rating score (VRS) from 1 to 10, 10 being most severe pain, were used for assessment of pain during the skin needle penetration and during the infiltration of the anesthetic product. RESULTS: Data of the VAS and of the VRS during the two steps, respectively, show no significant difference in pain rating between the two groups. In Group E, the gender of the patients had a significant effect on pain perception. Male patients reported less pain than female patients, both during the needle skin penetration and during the infiltration step (P < 0.005). In Group P, reported pain did not differ by gender in either step of the procedure. CONCLUSIONS: We found no clinical benefit in using EMLA during digital nerve block. Although the digital nerves are not deeply located in the small subcutaneous space of the digit, topical anesthesia may not reach them. Moreover, swelling due to injection of the anesthetic product in this small space may also amplify the sensation of pain.     

Comparison of topical anesthetics (EMLA/Oraqix vs. benzocaine) on pain experienced during palatal needle injection.

OBJECTIVE: The aim of this study was to compare the topical anesthetic effect of 20% benzocaine gel with 2.5% lidocaine/2.5% prilocaine (L/P) cream and gel on the pain experienced during palatal anesthetic infiltration. STUDY DESIGN: Two groups were studied, each containing 20 subjects. Two types of L/P mixtures were tested, an anesthetic cream (EMLA) and a thermosetting gel (Oraqix), and benzocaine was used as control. The topical agents were applied on the palatal mucosa at the canine region. A needle prick was given on each side every 2 minutes during a period of 10 minutes. The subjects recorded their findings using verbal and VAS scales. RESULTS: Pain scores were significantly less (P < .05) with EMLA and Oraqix than with benzocaine. CONCLUSION: Topical application of EMLA and Oraqix before palatal anesthetic infiltration is associated with less pain than with benzocaine gel.     

EMLA Versus Ice as a Topical Anesthetic

BACKGROUND: There are many different topical anesthetics available. Ice is an easy to use and inexpensive topical anesthetic. There are studies comparing different topical anesthetics but none have used ice. OBJECTIVE: To evaluate the efficacy between EMLA (2.5% lidocaine and 2.5% prilocaine cream) and ice prior to injection with a 30-gauge needle containing a painful stimuli. METHOD: A fingertip amount of EMLA cream was placed on the upper left arm and occluded with a bandage for an average of 52 minutes. Ice in a rubber glove was placed on the right upper arm for 1-2 minutes. The EMLA site, ice site, and a control site without anesthetic were tested for cutaneous analgesia with an injection of 1% lidocaine with 1:100,000 epinephrine through a 30-gauge needle using a 3 cc syringe. Discomfort was recorded using a visual acuity scale (VAS). Analysis of data was performed using a t test paired sample of two means. RESULTS: Statistically there was a significant difference in pain control between EMLA and ice (P <.05), EMLA and control (P <.01), and ice and control (P <.01). Clinically patients felt that EMLA performed slightly better as an analgesic than ice, and both EMLA and ice were more efficacious than the control. CONCLUSION: Both EMLA and ice decreased the discomfort associated with needle injection. Although EMLA performed better in pain control, ice has advantages in ease of use, fast action, and is less expensive than EMLA. Both EMLA and ice were good topical anesthetics, each with advantages and disadvantages in clinical use.     

Efficacy of EMLA cream, effect of time and place of application

OBJECTIVE: To evaluate the anesthetic efficacy of EMLA cream for alleviating pain associated with puncture and pressure in areas where venous catheters are normally inserted. MATERIAL AND METHODS: We performed a prospective, double blind study in 38 volunteers between 25 and 36 years of age, after obtaining informed consent. A 1.5 g dose of EMLA cream was applied to three sites on each patient: the back of the hand, the antecubital fossa and the side of the neck. Placebo cream with similar characteristics was applied to contralateral sites. Pain was evaluated on a visual analog scale (VAS, 0-10). Tactile sensitivity was assessed on a four-point scale (0 = no sensation; 1 = slight sensation; 2 = moderate, and 3 = strong). An analysis of variance study was performed to compare baseline scores to results over time, and placebo results to EMLA scores for each test site. RESULTS: The assessment of response to puncture and pressure gradually decreased over time for the sites where EMLA cream was applied, but not for the areas where placebo was applied. CONCLUSION: The efficacy of EMLA cream varies demonstrably depending on type of stimulus, site of application and time since application.     

High-Energy Pulsed Light Source Hair Removal Device Used to Evaluate the Onset of Action of a New Topical Anesthetic

BACKGROUND: Topical anesthetic agents are widely used to mitigate the pain associated with laser and high-energy pulsed light source hair removal. OBJECTIVE: To evaluate the relative efficacy and onset of action of a new topical anesthetic agent, ELA-Max cream (lidocaine 4%), relative to a widely used agent, EMLA cream (lidocaine 2.5%/prilocaine 2.5%). METHODS: ELA-Max and EMLA were applied to the forearms of 10 unblinded test subjects. The EMLA-treated sites were occluded for 1.5 hours prior to testing. The ELA-Max-treated sites were unoccluded and the cream was applied immediately prior to testing. Pulses from an Epilight high-energy pulsed light source were then administered 1.5 hours after occlusion with EMLA and in 5-minute intervals after application of ELA-Max. Pain scores were recorded on a visual analog scale (VAS). RESULTS: Six of 10 patients reported some anesthetic effect from ELA-Max after 5 minutes of unoccluded skin contact. Seven of 10 subjects reported maximal pain control 20 minutes after application of unoccluded ELA-Max, roughly equivalent to EMLA after 1.5 hours of occlusion. CONCLUSION: ELA-Max is an effective topical anesthetic agent comparable to EMLA under occlusion. It appears to be faster acting than EMLA, and along with its effectiveness without occlusion, may be an easier agent to use.     

Transdermal diclofenac patchvs eutectic mixture of local anesthetics for venous cannulation pain

PURPOSE: To compare the efficacy and side effects of transdermal diclofenac patch with eutectic mixture of local anesthetic (EMLA) cream in attenuating venous cannulation pain. METHODS: Adult ASA I or II patients undergoing elective surgery were randomly divided into three groups of 150 each. Group 1 (Control) patients received a placebo patch; Group 2 (EMLA) patients received EMLA cream; Group 3 (Diclofenac) patients received a transdermal diclofenac patch. The patches were applied at the proposed venous cannulation site 60 min prior to cannulation and pain resulting from an 18G cannula was assessed on an ten-point visual analogue scale (VAS). The cannulation site was observed for blanching, erythema, induration and edema for up to 24 hr. RESULTS: The incidence of venous cannulation pain was 100% in the control group, as compared to 37% and 48% of patients who experienced pain in the EMLA (P = 0.001) and diclofenac (P = 0.001) groups, respectively. The severity of venous cannulation pain [median (VAS) with interquartile ranges] was also higher in the control group: 6 (3) as compared to VAS sores of 0 (1) and 0 (2) in the EMLA (P = 0.001) and diclofenac (P = 0.001) groups. Blanching occurred with greater frequency in the EMLA group compared with the diclofenac (P = 0.001 at six hours) and placebo groups (P = 0.001 at six hours). Erythema, induration and edema were reduced in the diclofenac group compared with the EMLA (P = 0.001 for all comparisons) and placebo groups (P = 0.04 for edema at six hours and P = 0.001 for other comparisons). CONCLUSION: Transdermal diclofenac patch and EMLA are equally effective in reducing venous cannulation pain, but signs of erythema, induration and edema are less frequently observed with the transdermal diclofenac patch.     

Anesthetic effect of EMLA occluded with Orahesive oral bandages on oral mucosa. A placebo-controlled study.

The efficiency of a topical anesthetic occluded with Orahesive Oral Bandage was investigated. Experimental pain was provoked by needle insertions into two palatal test areas in 20 healthy subjects. Pain, estimated on a 100-mm visual analogue scale (VAS), decreased significantly from 23.5 mm to 10.5 mm at the greater palatine foramen and from 51.5 mm to 35.0 mm at the incisive foramen after application of a eutectic mixture of local anesthetics (EMLA). No significant change in pain perception was obtained after placebo application. The EMLA cream and the Orahesive Oral Bandages were well accepted by the subjects, as only two out of 20 subjects experienced slight gagging reflexes and only three considered the taste unpleasant. No other adverse reactions were observed. Occlusion of topical anesthetics seems to be a useful technique for achieving superficial mucosal anesthesia.     

The use of topical lidocaine/prilocaine cream prior to childhood circumcision under local anesthesia

A prospective study was conducted to evaluate the efficacy of prior application of topical eutectic mixture of local anesthetics, EMLA, in alleviating the pain associated with infiltration local anesthetic (LA) for circumcision in children and to assess its impact on the outcome. A total of 173 children aged 3-13 years requiring circumcision were randomly assigned to have EMLA or placebo cream applied over the root of the penis 1 h before subcutaneous ring block. A blinded observer rated the pain response on a 10-point visual scale during needle insertion, injection of local anesthetic and circumcision. Children needing conversion to general anesthesia (GA) were counted as failures. A total of 89 and 82 boys were included in the EMLA group and placebo group, respectively. Significantly lower pain scores were recorded for needle puncture in the former group (P<0.001), whilst pain scores for injection and during circumcision were not statistically different between the two groups (P=0.037 and 0.138, respectively). A total of 88 out of the 89 boys pre-treated with EMLA completed the procedure, whereas seven boys in the placebo group necessitated conversion to GA (P=0.022). The converted cases had higher values for all pain scores and tended to be younger. Therefore, EMLA cream is a useful adjunct to LA for childhood circumcision because it effectively reduces the sharp pain induced by needle puncture. However, careful patient selection is required for a low conversion rate to GA.     

EMLA partially relieves the pain of EMG needling

The aim of this study was to evaluate the efficacy of the topical analgesic cream EMLA in alleviating the pains caused by needling in electromyography (EMG). During the course of regular neurophysiology clinics, 34 Caucasian patients of both sexes, aged 21 to 69 yr (mean 38.5 +/- 11.4 SD), scheduled for electromyography, were studied. The EMLA was spread thickly on two EMG sites on each arm: E site, on the lateral dorsal aspect of the forearm and A site, on the thenar eminence. Randomization was pre-established. Whenever EMLA was applied blindly on one of the sites of the arm, the placebo was applied on the homologous site of the other arm. After at least 45 min of application (range 45-145 min, mean = 72.3 +/- 22.2), the needle was inserted into the skin and into the muscle. Then the electromyographist asked the patient to score his degree of pain on a visual analogue scale (VAS 1-10 cm) for each level of insertion. The results showed that on the skin of E site, the pain was less after EMLA than placebo (VAS = 0.75 +/- 1.36 vs 3.10 +/- 1.75, P = 0.0001). The untreated E site (placebo) was less sensitive than the untreated A site (VAS = 3.10 +/- 1.75 vs 6.09 +/- 1.96, P = 0.0001). Muscle insertion on E site was less painful on the EMLA sites than placebo (VAS = 2.83 +/- 2.45 vs 5.73 +/- 2.30, P = 0.0001). The VAS scores for skin and muscle insertion on A site were identical whether EMLA or placebo had been applied.(ABSTRACT TRUNCATED AT 250 WORDS)     

Evaluation of the analgesic efficacy of EMLA cream in volunteers with differing skin pigmentation undergoing venipuncture

BACKGROUND AND OBJECTIVES: Lidocaine/prilocaine cream (EMLA) applied to intact skin for 60 minutes has been shown to reduce venipuncture pain. Recent studies have suggested that lidocaine/prilocaine cream is less effective on heavily pigmented skin. The objective of this study was to evaluate the topical anesthetic efficacy of lidocaine/prilocaine cream in volunteers with varying skin pigmentation types. METHODS: Sixty volunteers were enrolled into each of three groups based on skin pigmentation history. Subjects were randomized to receive lidocaine/prilocaine cream onto the antecubital fossa of one arm and placebo cream on the comparable location of the other arm for either 60, 90, or 120 minutes prior to venipuncture. Assessments of perceived pain associated with each venipuncture were made by the subject using a visual analog scale. RESULTS: Lidocaine/prilocaine cream applied for 60 minutes significantly (P < .0001) reduced the pain of venipuncture compared to placebo regardless of the skin pigmentation type. Pain reduction did not differ significantly across skin types (P = .7986). Additional exposure up to 120 minutes did not change the efficacy of EMLA cream. CONCLUSIONS: Lidocaine/prilocaine cream is a safe and effective topical anesthetic for reducing pain associated with venipuncture in individuals, regardless of skin pigmentation.     

Comparative evaluation of myolaxin and EMLA cream for attenuation of venous cannulation pain: a prospective, randomised, double blind study

We evaluated the efficacy of topical Myolaxin (capsaican ointment, Geno, Mumbai) ointment over EMLA (eutectic mixture of lignocaine, prilocaine; Neon, Goa) cream for attenuating venous cannulation pain in this prospective, randomised, double blind study. Sixty adult patients undergoing elective laparoscopic cholecystectomy were randomly assigned into two equal groups. Group I (EMLA) received EMLA cream, whereas Group II (Myolaxin) received Myolaxin ointment. For both groups the cream was applied at the venous cannulation site (dorsum of the non-dominant hand) one hour prior to venous cannulation and was covered with an occlusive dressing. Following venous cannulation patients were asked if they felt pain during venous cannulation. If the answer was yes, they were asked to rate the severity of venous cannulation pain using a VisualAnalogue Scale (VAS) of 0-10. The incidence of venous cannulation pain was similar between groups: in the EMLA group 65% (18/28) compared to 67% (20/30) in the Myolaxin group (P=0.19). The severity of pain (median VAS with inter quartile range) was also similar between the groups: in the EMLA group 1.5 (3) compared to 1.5 (2) in the Myolaxin group (P=0.46). As the topical application of Myolaxin ointment is cheaper than EMLA and has similar efficacy, it may be a suitable alternative for reducing the incidence and severity of venous cannulation pain.     

Topical lidocaine-prilocaine cream (EMLA) for thoracostomy tube removal.

We prospectively studied topical lidocaine-prilocaine cream (EMLA) versus IV morphine in a double-blinded, randomized fashion for pain relief during thoracostomy tube (chest tube; CT) removal. Adult patients who had undergone thoracotomy or median sternotomy were randomized to receive either EMLA cream over CT sites transdermally for 3 h or IV morphine 0.5 h before CT removal. Pain behavior was observed and rated before, during, and after CT removal. Pain behavior increased less in the topical EMLA group (mean +/- SE, 4.4+/-0.39) compared with the IV morphine group (6.0+/-0.38; P < 0.01). No signs of infection were noted at the CT sites 24 or 48 h after CT removal. We conclude that EMLA cream is more effective than IV morphine in preventing the pain associated with CT removal. IMPLICATIONS: Postoperatively applying a topical anesthetic cream onto chest tube sites of chest surgery patients 3 h before chest tube removal is more effective than IV morphine in blunting pain response.     

Tolerability of prostate transrectal biopsies using gel and local anesthetics: results of a randomized clinical trial

PURPOSE: To evaluate the role of intrarectal EMLA, a new topical anesthetic cream, and lidocaine gel as local anesthesia during transrectal prostate biopsy and to observe whether gel temperature can improve pain control. PATIENTS AND METHODS: A series of 210 consecutive patients were randomized. Group 1 (N = 60) underwent intrarectal instillation of EMLA cream, group 2 (N = 50) 2.5% lidocaine gel, group 3 (N = 40) placebo, and group 4 (N = 60) no treatment. Patients in groups 2 and 3 were subdivided into subgroups according to instillation of warm or cooled gel. Pain control was assessed by a 10-point visual analog scale. RESULTS: The median pain scores were 2.6 in group 1, 3.8 in group 2, 3.9 in group 3, and 3.6 in group 4. In 16 patients (7.6%), the procedure was suspended because of pain: none group 1, 6.0% in group 2, 10% in group 3, and 15% ing group 4. The temperature of the lidocaine gel did not affect tolerability. Conclusion: Intrarectal instillation of EMLA cream is a simple, safe, and effective method of local anesthesia during transrectal prostate biopsy, superior to lidocaine gel, placebo, and no treatment.     

Both EMLA and placebo cream reduced pain during extracorporeal piezoelectric shock wave lithotripsy with the Piezolith 2300

BACKGROUND: The objectives were to determine whether a eutectic mixture of local anesthetic (EMLA) or placebo cream reduces pain during extracorporeal piezoelectric shock wave lithotripsy (EPSWL), and to determine which of the components of the application (i.e., the occlusive dressing, the cream, or the local anesthetic) contributes to analgesia. METHODS: A randomized, double blind, crossover study (part 1) was performed in 12 patients who were scheduled for EPSWL procedures on an ambulatory basis who received the first treatment without any intervention and who had verbal pain scores of 70 or more (on a 0-to- 100 scale). For the next two treatments at 2-week intervals, patients were randomly assigned to receive either 10 g EMLA or 10 g placebo cream and then crossed over to receive the other. The cream and occlusive dressing were left in place and immersed in water throughout the procedure. Verbal numeric pain score was assessed at 5 min after receiving the maximal tolerable intensity of shock wave and at the end of the procedure. The study continued (part 2) in 202 ambulatory patients; 125 men and 77 women, American Society of Anesthesiologists physical status I and II, subjected to EPSWL were randomly allocated into five groups who received (1) nothing on the skin (control), (2) plastic occlusive dressing, (3) placebo cream and plastic occlusive dressing, (4) EMLA cream and plastic occlusive dressing, (5) EMLA cream and plastic occlusive dressing for 60 min to achieve cutaneous anesthesia, which was removed before EPSWL. Pain score was evaluated 10 min into the procedure and at the end of the procedure. RESULT: Both parts of the study showed that patients who received either EMLA or placebo cream with dressing throughout the procedure experienced less pain and tolerated higher energy levels compared with the control. Patients who received only pre-EPSWL cutaneous anesthesia of EMLA and who received only the occlusive dressing did not have a reduction in pain score. CONCLUSIONS: EMLA and placebo creams under occlusive dressing reduced pain during EPSWL. The presence of the cream itself as a coupling medium contributed to analgesia. This may be a useful, simple, safe, and economical adjuvant technique to reduce pain during immersion EPSWL.     

The S-Caine Peel: A Novel Topical Anesthetic for Cutaneous Laser Surgery

BACKGROUND: The S-Caine peel (Zars, Inc., Salt Lake City, UT) is a novel eutectic lidocaine/tetracaine mixture that is applied as a cream, drying upon exposure to air to form a flexible film that can be peeled off easily. The patented formulation can be used to anesthetize the skin prior to a variety of cutaneous procedures. OBJECTIVE: To examine the clinical efficacy of the S-Caine peel as a topical anesthetic for pulsed dye laser (PDL) treatment and to determine the optimal application time for adequate cutaneous anesthesia. METHODS: Sixty patients were enrolled in one of three separate double-blind, placebo-controlled protocols in which the active product or a placebo was applied to the skin and left intact for 20, 30, or 60 minutes prior to laser treatment. A 585 nm or 595 nm PDL was used to treat facial telangiectases or port-wine stains in each protocol. Patients rated the level of pain experienced during laser treatment on a visual analog scale (VAS). Independent assessments of observed discomfort and side effects were recorded. RESULTS: All patients experienced significant pain reduction with the S-Caine peel as their sole topical anesthetic. An application time of 20 or 30 minutes was as effective as 60 minutes in achieving anesthesia. Side effects of the peel application were limited to transient mild erythema. CONCLUSION: The S-Caine peel is a rapid, safe, and effective method of topical anesthesia for cutaneous PDL treatment.     

Eutectic mixture of local anaesthetics is not effective for extracorporeal shock wave lithotripsy

Purpose

Eutectic mixture of local anaesthetics (EMLA®) produces cutaneous analgesia. This randomized, double blind, placebo controlled study evaluated the efficacy of EMLA cream during extracorporeal shock wave lithotripsy (ESWL) using the Dornier® MFL 5000 lithotripter.

Methods

Patients scheduled to undergo lithotripsy of renal or pelviureteric junction stones were randomized to receive either 30 g EMLA cream (E) or placebo (P) over the kidney area 60–90 min before the procedure. During lithotripsy all patients received alfentanil via a PCA machine (dose —10 μ · kg^?1, lockout time —three minutes, no basal infusion). Additional bolus doses of 5 μg · kg^?1 alfentanil were administered by the anaesthetist if analgesia was inadequate. Visual analogue scores (VAS) for pain were documented prior to application of the cream. On arrival in the post anaesthesia care unit VAS pain scores were documented for maximum pain and average pain felt during the procedure as well as for satisfaction of the analgesic technique used. Total time spent in the PACU and the Aldrete scores on arrival were compared.

Results

Eighty-three patients completed the study. Demographic data were similar between the two groups. Also, VAS for maximal pain, average pain and satisfaction and the total number of shock waves were similar although the EMLA group received more shock waves at the lower energy level (kV) (P < 0.0001). Total dose of alfentanil, dose as boluses, rate of alfentanil use, total number of PCA attempts and missed attempts were similar. The incidence of adverse events such as bradypnoea, airway obstruction, transient hypoxaemia, pruritus and nausea were small and similar. There was a slightly higher incidence of inadequate analgesia documented by the anaesthetist in the EMLA group. There was no difference between the groups with regards to duration of stay in the PACU, incidence of nausea or Aldrete scores on admission to PACU.

Conclusions

During lithotripsy EMLA cream does not modify the pain perceived nor does it have any opioid sparing effect. It does not facilitate early discharge from the PACU.     

Use of the anesthetic cream EMLA in arterial punction

INTRODUCTION: Arterial puncture is a painful procedure requiring prior local anesthesia. Various products are available for pain relief, among them EMLA anesthetic cream. OBJECTIVE: To compare pain from simple puncture of the radial artery performed with or without application of EMLA anesthetic cream and after infiltration of mepivacaine. PATIENTS AND METHODS: A prospective, random double-blind study of 153 patients in three groups: group A, 51 patients who were applied 1 g of EMLA cream; group B, 52 patients who were applied 1 g of placebo cream; and group C, 50 patients who received infiltration of 0.2 ml of 1% mepivacaine. Pain was assessed on a 10 cm visual analog scale (0, absence of pain; 10, greatest imaginable pain). RESULTS: Pain intensity reported by the patients was 2.6 +/- 1.8 in group A, 2.9 +/- 1.8 in group B and 1.6 +/- 1.8 in group C. The results for group C were statistically different from those for groups A and B. The difference between groups A (EMLA) and B (placebo), however, was not statistically significant. CONCLUSIONS: Mepivacaine infiltration is the more effective method for minimizing pain from puncture of the radial artery. EMLA anesthetic cream is not effective against pain caused by this procedure.     

Both EMLA and Placebo Cream Reduced Pain during Extracorporeal Piezoelectric Shock Wave Lithotripsy with the Piezolith 2300

Background: The objectives were to determine whether a eutectic mixture of local anesthetic (EMLA) or placebo cream reduces pain during extracorporeal piezoelectric shock wave lithotripsy (EPSWL), and to determine which of the components of the application (i.e., the occlusive dressing, the cream, or the local anesthetic) contributes to analgesia.

Methods: A randomized, double blind, crossover study (part 1) was performed in 12 patients who were scheduled for EPSWL procedures on an ambulatory basis who received the first treatment without any intervention and who had verbal pain scores of 70 or more (on a 0-to-100 scale). For the next two treatments at 2-week intervals, patients were randomly assigned to receive either 10 g EMLA or 10 g placebo cream and then crossed over to receive the other. The cream and occlusive dressing were left in place and immersed in water throughout the procedure. Verbal numeric pain score was assessed at 5 min after receiving the maximal tolerable intensity of shock wave and at the end of the procedure. The study continued (part 2) in 202 ambulatory patients; 125 men and 77 women, American Society of Anesthesiologists physical status I and II, subjected to EPSWL were randomly allocated into five groups who received (1) nothing on the skin (control), (2) plastic occlusive dressing, (3) placebo cream and plastic occlusive dressing, (4) EMLA cream and plastic occlusive dressing, (5) EMLA cream and plastic occlusive dressing for 60 min to achieve cutaneous anesthesia, which was removed before EPSWL. Pain score was evaluated 10 min into the procedure and at the end of the procedure.

Result: Both parts of the study showed that patients who received either EMLA or placebo cream with dressing throughout the procedure experienced less pain and tolerated higher energy levels compared with the control. Patients who received only pre-EPSWL cutaneous anesthesia of EMLA and who received only the occlusive dressing did not have a reduction in pain score.     

Comparison of topical anesthetic cream (EMLA) and diclofenac suppository for pain relief after hemorrhoidectomy: a randomized clinical trial

Purpose

We compared the efficacy and side effects of diclofenac and a topical eutectic mixture of local anesthetics (EMLA) for pain relief after hemorrhoidectomy.

Methods

Ninety patients, nominated for elective hemorrhoidectomy, were recruited for this randomized clinical trial and were randomly categorized into three groups (30 patients in each group). After surgery, the patients in the first group received one 100?mg diclofenac suppository, those in the second group received 5?g of EMLA, and those in the third group received 5?g of petrolatum ointment (control group). The pain intensity was measured using a visual analog scale (VAS). Twenty-five mg of intramuscular pethidine was administered upon the patient’s request. Pain measurements were performed on the patient’s transfer to the recovery ward, 2?h after surgery, the evening and the morning after surgery.

Results

The EMLA group yielded the lowest VAS score on transfer to recovery and at 2?h after surgery (p?<?0.05). The diclofenac group reported the lowest VAS score in the evening and the morning after surgery (p?<?0.05).

Conclusions

Topical use of an EMLA cream is appropriate for short-term pain control following hemorrhoidectomy, while diclofenac yields a more sustainable pain control.