Eutectic mixture of local anesthetics reduces pain during intravenous catheter insertion in the pediatric patient.

OBJECTIVE: The objective of this study was to explore the relation between the application of a mixture of lidocaine/prilocaine cream (eutectic mixture of local anesthetics [EMLA]) before intravenous cannula insertion and perceived pain in the pediatric patient. DESIGN: Double-blind placebo-controlled trial. SETTING: A general inpatient pediatric ward. PATIENTS: We examined 26 male and 31 female patients between the ages of 4 and 12 years who required intravenous cannula insertion. Intravenous insertion was performed on 57 patients, with 29 patients in the placebo group (mean age, 8.1 years) and 28 in the EMLA group (mean age, 8.0 years). INTERVENTIONS: Application of either EMLA cream or placebo 45 minutes before intravenous cannulation. OUTCOME MEASURES: Pain was scored by the patients using a 0- to 10-cm visual analogue scale combined with a Faces pain scale as well as visual observation by a nurse. Adverse side effects were recorded in a separate table. RESULTS: Data collected and the differences between the placebo and treated groups were tested using a Mann-Whitney U test. Those children in the EMLA group (mean pain score, 1.25) experienced less pain than those in the placebo group (mean, 8.39). There was no statistical significance between age, sex, and race. CONCLUSIONS: The authors conclude that a topical preparation of lidocaine/prilocaine significantly reduces children's pain during intravenous cannula insertion when applied to an intact dermal layer of the skin and that this effect occurs within 45 minutes.     

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.     

A comparison of EMLA cream and amethocaine gel for topical cutaneous analgesia in children

The efficacy of EMLA cream and amethocaine gel was compared using application times of greater than 60 minutes. Eighty eight patients received EMLA cream and 89 received amethocaine gel. Pain during venous cannulation was assessed by a single observer using a four point observational scale. Sixty nine (78%) patients in the amethocaine group underwent pain-free venepuncture compared with 46 (52%) patients in the EMLA cream group (p<0.001). No serious side effects occurred in any patient. As well as having a faster onset of action, amethocaine gel also appears to be a more effective analgesic than EMLA cream prior to venous cannulation in children.     

LET versus EMLA for Pretreating Lacerations: A Randomized Trial

OBJECTIVE: To compare the anesthetic efficacy of EMLA cream (eutectic mixture of local anesthetics) with that of LET solution (lidocaine, epinephrine, tetracaine) for pretreating lacerations prior to lidocaine injection. METHODS: This was a randomized, double-blind clinical trial in a convenience sample of 60 patients aged 1 to 59 years with traumatic lacerations. Eligible wounds were uncomplicated, clean lacerations < or = 6 hours old. Finger and toe lacerations were excluded. At the time of initial presentation to triage, patients were randomized to LET or EMLA. A nurse applied the topical anesthetic into the laceration with a 5-mL syringe. A physician assessed the laceration edges for the presence of blanching and adequacy of anesthesia to a 27-gauge needlestick. Supplemental lidocaine was then infiltrated through the wound edges and the pain of infiltration was recorded by the patient (or guardian) on a 100-mm visual analog scale marked "most pain" at the high end. A sample of 44 patients had 90% power to detect a 20-mm difference in injection pain (two-tailed alpha = 0.05). RESULTS: Sixty patients were randomized to LET (29) or EMLA (31). Median age was 8.5 years; 23% were female. Most lacerations were facial and closed with sutures. There was no difference in baseline characteristics between groups. More wounds treated with LET were anesthetic to a needlestick than wounds treated with EMLA (73% vs 40%, p = 0.01); however, there was no between-group difference in the median pain of lidocaine infiltration (LET-12 mm vs EMLA-13 mm, p = 0.89). CONCLUSIONS: Pretreatment of simple lacerations with LET or EMLA at the time of patient presentation results in similar amounts of pain of subsequent local infiltration of lidocaine     

Effect of Topical Analgesia on Desensitization Following 8% Topical Capsaicin Application

To prevent pain associated with 8% capsaicin application, pretreatment with local anesthetics, such as EMLA (eutectic mixture of lidocaine 2.5% and prilocaine 2.5%), is considered an option. However, there is contradicting evidence regarding the effects of local analgesia on capsaicin-induced desensitization. In session 1, 2 skin areas in each forearm of 24 healthy volunteers were randomized to 2-hour pretreatment with EMLA/placebo cream. After pretreatment, 8% capsaicin patches were applied for 3 hours in 1 placebo and 1 EMLA pretreated area, obtaining the following four areas: Capsaicin + EMLA, Capsaicin + Placebo, EMLA alone, and Placebo. Pain intensity scores were assessed during the 3-hour application of capsaicin. Warmth detection, heat pain sensitivity, and microvascular reactivity were measured after the removal of capsaicin. After 24 hours, in session 2, all tests were repeated followed by histamine application in each area to examine itch intensity and neurogenic flare.Overall, EMLA caused significant reductions in capsaicin-induced pain compared with placebo (P= .007) and enhanced the capsaicin-induced increase in superficial blood perfusion immediately after the 3-hour capsaicin application (P< .01). Regardless of pretreatment, capsaicin induced heat hyperalgesia immediately after the application (P< .001). Twenty-four hours post application, heat pain sensitivity was normalized. However, WDT increased significantly (P< .001). Capsaicin tended to reduce the itch intensity and significantly reduced the neurogenic flare (P< .05) induced by histamine compared with EMLA alone. The findings suggest that pretreatment with topical analgesic cream reduces application site pain without interfering with the 8% topical capsaicin-induced desensitization.PerspectivePretreatment with local anesthetic EMLA cream might be considered a good therapeutic option to reduce the pain associated with 8% capsaicin application currently used for treatment of neuropathic pain syndromes. This study also suggests the existence of a synergistic effect of capsaicin and EMLA on the process of neurogenic inflammation.     

Evaluation of a low-dose lidocaine iontophoresis system for topical anesthesia in adults and children: a randomized, controlled trial

BACKGROUND: Commonly used classes of topical anesthetics require 30 to 60 minutes to provide effective anesthesia. A new low-dose lidocaine iontophoresis system (LDLIS) may provide topical anesthesia in 10 minutes at a lower dose than previous systems, thereby limiting adverse events. METHODS: This was a prospective, randomized, multicenter, double-blind, placebo-controlled, clinical trial. Adults and children aged 5 to 17 years (inclusive) received a 10-minute ionntophoretic treatment with either lidocaine or a saline placebo before venipuncture or venous cannulation. Intensity of pain associated with venipuncture or venous cannulation was assessed using either a 10-cm Visual Analog Scale (VAS) for adults and children aged 12 to 17 years or the Facial Affective Scale (FAS) for all children enrolled. RESULTS: Five hundred forty-eight patients (276 adults, 272 children) participated. Mean (SD) VAS pain scores were lower in adults who received iontophoresis with lidocaine rather than with placebo (0.77 [1.49] vs 2.52 [2.30], P < 0.001) and in children aged 12 to 17 years (1.50 [1.87] vs 2.58 [2.26], P = 0.001). FAS pain scores were lower among children who received iontophoresis with lidocaine rather than with placebo (0.36 [0.26] vs 0.51 [0.27], P < 0.001). Similar results were found for children stratified by age group (5-7 years: 0.40 [0.30] vs 0.60 [0.31], P = 0.011; 8-11 years: 0.35 [0.27] vs 0.48 [0.27], P = 0.021; 12-17 years: 0.33 [0.21] vs 0.48 [0.24], P = 0.001). Mean (SD) parental ratings of pain on the FAS for children aged 5 to 11 years were also lower for the lidocaine group (0.45 [0.28] vs 0.55 [0.25], P = 0.018). Adverse events were similar between groups and included skin erythema and edema. One patient in the study experienced a partial-thickness burn. CONCLUSION: In this study of adults and children, the LDLIS provided effective topical anesthesia for venipuncture and venous cannulation within 10 minutes.     

国产盐酸丁卡因凝胶用于介入治疗动脉插管术前皮肤局部麻醉作用的临床研究

目的 研究盐酸丁卡因凝胶用于介入治疗动脉插管术前的麻醉效果及临床安全性。方法 选取需行动脉穿刺插管病人40例。采用单盲随机平行对照观察方法分为两组。其中试验组和对照组各20例。用药后穿刺右股动脉，观察局部麻醉作用、插管时瞬间疼痛及不良反应。结果 两组病人局部麻醉作用显效率分别为85％、90％，有效率均为100％。插管时瞬间疼痛比较镇痛有效率分别为95％、100％。两组均未出现不良反应。结论 盐酸丁卡因凝胶麻醉效果好，操作简单，无创伤无痛苦，临床安全性好，无明显不良反应，可用于介入治疗动脉插管术前的局部麻醉。     

The use of EMLA cream to decrease venipuncture pain in children

Venipuncture is one of the most painful medical procedures for a child, and it is one of the most frequently performed. This literature synthesis reviews evidence for the use of eutectic mixture of local anesthetics (EMLA) cream to reduce the pain children experience during venipuncture. EMLA cream was compared with placebo, iontophoresis, and amethocaine cream and was found to be an effective local anesthetic for pediatric venipuncture pain during both intravenous cannulation and phlebotomy.     

Topical anaesthesia in haemodialysis: Evaluation of topical anaesthesia with lidocaine during vascular access in children undergoing long-term haemodialysis for chronic renal failure

Türkmen M, Kavukçu S, Soylu A, Ay N, Sevinç N, Sersan R. International Journal of Nursing Practice 1997; 3: 79–83
Topical anaesthesia in haemodialysis: Evaluation of topical anaesthesia with lidocaine during vascular access in children undergoing long-term haemodialysis for chronic renal failure
Children with chronic renal failure are frequently exposed to painful invasive procedures. Ointments containing lignocaine-prilocaine, when used before intravenous punctures, have been reported to lessen the pain sensation. The aim of this study was to interpret the effectiveness of lidocaine 2.5% ointment in preventing pain when used before venous and arterial punctures in children undergoing a haemodialysis programme for chronic renal failure. Eight children were included in this study. The pain level was identified by the patients using a linear analogue scale. When topical anaesthetic and placebo were compared, there was no statistical difference in interpretation of pain during arterial ( P >0.4), venous ( P >0.375) or both ( P >0.4) procedures. We conclude that lidocaine 2.5% ointment is not effective in preventing pain in children undergoing long-term haemodialysis. In these patients some other factors, like psychological factors, puncture technique and needle size must be taken into consideration for the prevention of pain.     

1% lidocaine injection, EMLA cream, or "numby stuff" for topical analgesia associated with peripheral intravenous cannulation.

The purpose of this study was to assess patient's perception of pain associated with peripheral intravenous (i.v.) cannulation, using 3 methods of applying local anesthetics. A prospective, randomized, quasi-experimental study was conducted, using a convenience sample of men and women, ASA physical status I, II, or III, undergoing outpatient or same-day surgery. Group 1 received a subcutaneous injection of 1% lidocaine, group 2 received topical EMLA cream for 45 to 60 minutes, and group 3 received treatment with "Numby Stuff" for 40 mA minutes. After the intended analgesic treatment was complete, the patient was asked to rate the pain experienced during the skin-numbing process. An i.v. was then started using an 18-gauge i.v. catheter, and the patient again was asked to rate the amount of pain experienced with the catheter insertion. A visual analog scale was used as the tool of measurement for pain. Results of the study showed that group 1 experienced a higher treatment pain score than either group 2 or group 3, while group 2 experienced a higher pain score when the i.v. was started than either group 1 or group 3. Of the 3 methods tested, results seem to indicate that the Numby Stuff system using iontophoresis is the superior method for decreasing the pain associated with peripheral i.v. cannulation, and application of the analgesic method does not cause significant pain.     

Does Topical Lidocaine Attenuate the Pain of Infiltration of Buffered Lidocaine?

Objective: To determine whether topical lidocaine attenuates the pain of buffered lidocaine infiltration.
Methods: This was a prospective, randomized, double-blind, placebo-controlled trial conducted at a university-based ED. The subjects were adults who had lacerations being repaired using local anesthesia. Two 0.5-mL injections of buffered lidocaine were given in a standardized manner. The first was given prior to application of topical study solution. The second was given on the opposite side of the laceration after topical application of study solution, which was 5 mL of either 2% lidocaine or saline placebo. The pain of each infiltration was measured using a visual analog pain scale. Pain scores were calculated and compared using a Wilcoxon test with significance defined as p 0.05.
Results: A total of 54 subjects participated; 29 received lidocaine topically and 25 received placebo. The groups were similar with respect to age, gender, wound length, wound location, and initial pain score. Pain scores decreased by 11.6 ± 18.6 mm for lidocaine and 10.9 ± 20.9 mm for placebo (p > 0.5). The study had the power to detect a 15-mm pain score difference (α = 0.05 and β = 0.20) on a 100-mm scale.
Conclusion: Topical 2% lidocaine does not attenuate the pain of infiltration of buffered lidocaine more than does topical normal saline. Investigation of other topical anesthetics with and without epinephrine in conjunction with buffered lidocaine is warranted.     

Laser-assisted Anesthesia Prior to Intravenous Cannulation in Volunteers: A Randomized, Controlled Trial

Background: Intravenous cannulation is common and painful. Absorption of topical anesthetics is limited by the stratum corneum, the outermost layer of the epidermis. A single pulse of an erbium:yttrium–aluminum–garnet (Er:YAG) laser irradiation can remove an area of the stratum corneum, leading to enhanced uptake of topical agents, such as lidocaine, while leaving the rest of the epidermis intact. Objective: The authors hypothesized that pretreatment of the skin with laser‐assisted anesthesia would reduce the pain of venous cannulation. Methods: This was a blinded, randomized, controlled clinical trial. Subjects were 30 healthy adult volunteers. Standardized venous cannulation was performed on the dorsum of both of each subject's hands. In the study hand, the area over the target vein was pretreated with a lightweight, portable Er:YAG unit, with a fluence of 3.5 J/cm², a pulse width of 600 microseconds, and a spot diameter of 6 mm. Lidocaine 4% cream was applied to the area. After 5 minutes, the cream was wiped off and a nurse inserted an intravenous (IV) catheter and verified placement. In the control hand, a sham laser was used. Pain of laser application and pain of IV cannulation were recorded on a validated 100‐mm visual analog scale (VAS) marked “most pain” at the high end. The presence of burns, infection, and scarring at one week and at three months after the study was also noted. The levels of pain of cannulation were compared using a paired t‐test. Results: Mean subject age was 32 years; 43% were female. The mean pain of cannulation after laser‐assisted lidocaine application (13 mm, 95% CI = 8 to 19) was significantly less than after application of sham laser (29 mm, 95% CI = 22 to 36; mean difference, 15 mm, 95% CI = 6 to 24). No subject had persistent erythema or scarring. Conclusions: Pretreatment of the skin with a laser device followed by a 5‐minute topical lidocaine application reduces the pain of IV cannulation in volunteers.     

1％利多卡因局部注射减轻静脉留置针穿刺疼痛的效果

目的观察1％利多卡因局部注射后行18G静脉留置针穿刺的效果。方法将100例行静脉留置针穿刺的患者随机分为局部麻醉组50例,对照组50例。局部麻醉组采用1％利多卡因0．2ml局部注射后行静脉留置针穿刺,对照组直接行静脉留置针穿刺,对两组患者穿刺疼痛情况进行评分。结果局部麻醉组患者无痛25例,轻度疼痛24例,中度疼痛1例,重度疼痛0例;对照组患者无痛0例,轻度疼痛8例,中度疼痛31例,重度疼痛11例,两组比较差异有统计学意义（Z=-8．136,P〈0．01）。结论1％利多卡因局部注射后行18G静脉留置针穿刺可减轻患者的疼痛。     

Topical ketamine as a local anesthetic agent in reducing venipuncture pain: A randomized controlled trial

AimPain control is an important aspect of ED patient management, and there are many different protocols used around the world influenced by both availability of local resources as well as staff competency and experience. This study aims to evaluate the use of topical ketamine in acute pain reduction by directly comparing it to lidocaine-prilocaine (EMLA) cream.Materials and methodsIn this randomized clinical trial, 300 adult patients classified as level 4 or 5 by ESI triage system were enrolled. These patients were divided randomly into three groups. The site of venipuncture was covered with 2 g of topical ketamine cream 10% in group one, 2 g of 5% EMLA cream in group two, and finally, in group 3 (control group), was covered with placebo (2 g of cold cream). The primary end point of the study was reported pain severity with secondary end points being onset of local anesthesia as well as any side effects noted.ResultsThe data gathered showed pain score during venipuncture in both intervention groups were significantly lower when compared to the control group (P < 0.05). However, pain score did not differ between the 2 intervention groups (P = 0.395). There was no statistically significant difference between the ketamine or EMLA in onset of local anesthesia (P = 0.419). We noted itching and irritation was significantly higher in the EMLA group when compared to ketamine(P < 0.05).ConclusionThis study showed that local cutaneous ketamine is as effective as EMLA in relieving pain during venipuncture.     

Pain management of arteriovenous fistula cannulation in haemodialysis children: Efficacy of EMLA anaesthetic cream

The aim of the present study was to evaluate the efficacy of EMLA cream (containing a eutectic mixture of local anaesthetics) in controlling pain due to arteriovenous fistula cannulation in teenagers undergoing chronic haemodialysis. The study was conducted in two phases, one prospective, the other a blind randomized trial, at the Paediatric Haemodialysis service of the Paediatrics Department of Padua University, Italy. It involved six teenagers, aged 12–18 years. Pain was measured using the visual analogue scale, indirect evaluation by nurses and a four-category verbal rating scale. Results showed that: (1) the visual analogue scale calls for an adequate training period; and (2) the EMLA cream might be effective in controlling cannulation-related pain but emotional factors, such as uncontrolled fear and stress, can interfere with the global efficacy of the analgesic approach.     

Topical lidocaine patch relieves a variety of neuropathic pain conditions: an open-label study. (Department of Pain Medicine and Palliative Care, Beth Lsrael Medical Center, New York, NY) Clin J Pain 2000;16:205–208.

Our goal was to perform a pilot, open‐label, prospective study to access the effectiveness and tolerability of a topical lidocaine patch (Lidoderm) for the treatment of peripheral neuropathic pain conditions other than postherpetic neuralgia. Sixteen patients with refractory peripheral neruopathic pain conditions who had reported intolerable side effects or inadequate pain relief with antidepressant, anticonvulsant, antiarrhythmic, and opioid medications participated in this study. Diagnoses included postthoracotomy pain, stump neuroma pain, intercostal neuralgia, diabetic polyneuropathy, meralgia paresthetica, complex regional pain syndrome, radiculopathy, and postmastectomy pain. A 6‐item Pain Relief Scale was used. Moderate or better pain relief was reported by 13 of the 16 participants (81%). One patient stopped treatment after 4 days due to lack of relief. The remaining 15 patients had a mean duration of patch use of 6.2 weeks with continued relief. Only 1 patient reported a side effect, a mild skin irritation. Conclude the Lidoderm patch provides clinically meaningful pain relief in most of these refractory neuropathic pain patients without side effects. Controlled trials need to be performed to confirm these preliminary findings. Comment by Tat‐Leang Lee, M.D. This is an interesting study that highlighted a simple, efficacious method for the treatment of resistant neuropathic pain. As this was a pilot study using an open‐label method, and treating a heterogenous group of neuropathic pain conditions, caution should be adopted in the interpretation of the results. What remains unanswered is the reason for the success of the lidocaine patch, particularly when previous studies have documented the failure of EMLA in the treatment of neuropathic pain. Indeed, several patients who participated in this study had used EMLA unsuccessfully before, although no details on its administration was reported. Both the lidocaine patch and EMLA contain 5% lidocaine, which presumably would result in greater penetration by the EMLA cream. Therefore, a placebo‐controlled randomized trial is needed to confirm the findings of this pilot study. Nevertheless, this is a promising treatment that is convenient, lacks systemic effect, easily added‐on to existing treatment, and with only minor side effects, that is worth considering for our patients.     

Reducing Pain Associated with Arterial Punctures for Blood Gas Analysis

Arterial punctures for arterial blood gases (ABGs) analysis are described as the most painful laboratory procedure and are performed without the benefit of pain management. This study originated from one nurse's concern about the level of pain her hospitalized patients endured when she drew their ABGs. A review of the literature found that ABG pain relief has not been studied in hospitalized patients. Therefore, this study explored the question “Can the pain of arterial blood gas draws be reduced through the use of infiltration with a local anesthetic agent?” This study compared the pain scores of 40 hospitalized patients who received either no intervention or one of three analgesic interventions (infiltration of 0.7 ml 1% lidocaine, 0.7 ml buffered 1% lidocaine, or 0.7 ml of bacteriostatic saline at the arterial puncture site). Results showed that, although lidocaine and buffered lidocaine are effective in reducing the pain associated with the arterial puncture, plain lidocaine was the only intervention in which the pain rating score for the overall experience was significantly diminished. This study is limited by partial randomization, small sample size, and patient duress; however, it provides a foundation for further nursing research that explores methods to reduce the pain associated with this very painful procedure. Future studies should be directed at larger, diverse populations, multiple operators, and comparison of interventions to topical analgesics and nonpharmacological measures.     

Topical lidocaine in the treatment of partial-thickness burns

The analgesic properties and systemic absorption of topical lidocaine in the treatment of partial-thickness burns were evaluated by applying a 5% lidocaine cream to the burn wound at a concentration of 1 mg/cm2. The plasma lidocaine level was measured in 24 patients 15, 30, 60, 120, and 240 minutes after application. Systemic analgesics were given 30 minutes before application of the lidocaine cream. The Visual Analog Scale was used to record pain intensity in 30 patients just before and 30 minutes after application of the lidocaine cream. The maximal area treated was 28% total body surface area partial-thickness burn with application of 4.5 gm of lidocaine, resulting in a plasma level of 5.8 micrograms/ml. The plasma lidocaine level was constant during the 4-hour experiment and was associated with a significant decrease in pain. No infectious, allergic, or cardiovascular complications were observed. Our results indicate that topical lidocaine cream offers significant pain relief of long duration without associated systemic side effects.     

Ultrasound with Topical Anesthetic Rapidly Decreases Pain of Intravenous Cannulation

Objectives: Physicians and nurses in the emergency department rarely use topical anesthesia when starting intravenous (IV) lines because of time constraints and lack of data on patients' perception of the pain associated with this procedure. Ultrasound pretreatment of skin increases permeation rates of hydrophobic topical medications, including topical lidocaine. The objective of this study was to demonstrate that ultrasound treatment followed by brief application of topical anesthetic decreases the patients' perception of the pain of IV cannulation. Methods: This was a randomized, controlled, prospective trial performed in a university hospital emergency department. Eighty-seven consecutive English-speaking, subcritically injured or ill adult patients able to give consent who were receiving an IV line as part of their care were enrolled. The intervention was a brief ultrasound treatment using the SonoPrep (Sontra Medical Corp., Franklin, MA) therapeutic ultrasound device (frequency, 53–56 kHz) followed by 5 minutes of 4% liposomal lidocaine cream and standard-care IV cannulation, or standard care alone. Participants rated their pain on a visual analog scale. Researchers assessed the site after IV insertion and 20–36 hours later. The primary outcome was participants' subjective pain score, and the secondary outcome was site skin irritation. Results: The ultrasound group reported significantly less pain (p<0.001), with 80% of treated participants reporting pain scores ≤3 versus only 37% of controls (p <0.001). Conclusions: The SonoPrep ultrasound device applied to skin for 15 seconds followed by 5 minutes of 4% liposomal lidocaine cream significantly reduced patients' perception of the pain of an IV start when compared with standard care. There were no adverse side effects noted in any participant during the 36 hours of the follow-up period.     

复方利多卡因乳膏在分娩镇痛穿刺点涂抹效果分析

目的评价复方利多卡因乳膏在分娩镇痛穿刺点涂抹的镇痛效果。方法采用前瞻性分析方法,选取2018年7月至2019年7月美中宜和妇儿医院行椎管内分娩镇痛的孕足月单活胎初产妇[美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级为Ⅰ或Ⅱ级]400例。采用随机数字表法随机分为两组(各200例),复方利多卡因乳膏局部涂抹组为A组,安慰剂涂抹组作为对照组(B组)。复方利多卡因乳膏及安慰剂在产妇分娩镇痛操作前15 min均匀涂抹于分娩镇痛穿刺点及周围。宫口开2 cm时行分娩镇痛,按照视觉模拟评分法(visual analogue scale,VAS)评估分娩镇痛操作时疼痛情况和分娩镇痛后72 h内腰背痛情况。结果A组有18例改行剖宫产,B组19例改行剖宫产,均剔除本研究。两组产妇麻醉操作时均无无痛和轻度疼痛发生。A组中度疼痛为100%(182/182),无重度疼痛例数;B组中度疼痛为27.07%(49/181),重度疼痛为72.93%(132/181);两组比较,A组疼痛程度明显减轻,差异有统计学意义(Z=208.575,P<0.001)。分娩镇痛后72 h内腰背痛发生情况无、轻度、中度、重度A组分别为136、27、15、4例,B组分别为89、54、27、11例,两组比较A组疼痛程度明显减轻,差异有统计学意义(Z=25.510,P<0.001)。结论复方利多卡因乳膏涂抹分娩镇痛穿刺点有助于减轻分娩镇痛操作时产生的穿刺痛和分娩镇痛后出现的腰背痛。