PURPOSE: Newborns routinely experience pain associated with invasive procedures such as blood sampling, venipuncture, heelstick, or venous cannulation. This study was done to provide data for a nursing intervention to alleviate newborn pain clinically by investigating the effect of local anesthetic cream during venipuncture. METHODS: Participants were 70 newborns hospitalized in the nursery. Informed Consent was obtained from parents of the newborns. Venipuncture for regular blood sampling was carried out for a test on 2 groups; the experimental, placebo group. The neonatal infant pain scale (NIPS), and duration of crying were measured to assess pain reaction. All neonatal behaviors were recorded on videotape. RESULTS: There were significant differences in pain behavior during venipuncture (t=-4.752, p<.001), immediately after sampling (t=-5.591, p<.001), 3 minutes after puncture (t=-2.469, p=.017), and in duration of crying (t=-3.005, p=.004). CONCLUSION: Results show that local administration of EMLA cream before venipuncture causes a reduction in neonatal pain response, indicating that the EMLA cream has the effect of pain relief.
Catheterization ; Crying ; Humans ; Infant ; Infant, Newborn ; Informed Consent ; Lidocaine ; Nurseries ; Parents ; Phlebotomy ; Prilocaine ; Punctures ; Child Health

BACKGROUND: The purpose of the current study is to create a new mixture of local anesthetics-one with a short time of block development and short action term (5 ml of 1% lidocaine solution) and another with a longer time of anesthesia development and a long analgetic effect (5 ml of 0.75% ropivacaine)-for use during surgical operations on extremities. The primary end point was the development of the complete sensory block of the sciatic nerve. METHODS: Sixty blocks of sciatic nerve were used in a double-blind randomized research, under ultrasonic guidance, using an electric stimulator with the peripheral nerves. Sixty patients were divided into 3 equal groups. In the first group, a sciatic nerve block was performed with 5 ml of 0.75% ropivacaine solution (37.5 mg); in the second group, 10 ml of 0.75% ropivacaine solution (75 mg) was used and, in the third group, a mixture of 5 ml of 0.75% ropivacaine (as above) and 5 ml of 1% lidocaine solution (50 mg) was used. The assessment of the time required for developing sensory and motor blocks was carried out from the beginning of local anesthetic solution injection in the fascial sheath of the sciatic nerve. RESULTS: Demographic data of patients were identical in the three sample groups. The time required for achieving a complete motor and sensory block was reduced due to the mix of the 1% lidocaine solution with the 0.75% ropivacaine solution. The time required for achieving a complete sensory block in groups treated with 5 and 10 ml ropivacaine was 45 (40-48) and 30 (28-30) min, respectively, in contrast with 12 (10-13) min when the mixture of anesthetics was applied (P < 0.01). There was no difference in analgesic duration in the postoperative period among groups at P > 0.05. CONCLUSIONS: The mixture of 5 ml of 1% lidocaine with 5 ml of 0.75% ropivacaine leads to a reduction in the time required for the development of complete sensory and motor blocks of the sciatic nerve, without reducing postoperative analgesia time.
Amides ; Analgesia ; Anesthesia ; Anesthetics ; Extremities ; Humans ; Lidocaine ; Peripheral Nerves ; Postoperative Period ; Prilocaine ; Sciatic Nerve ; Ultrasonics

BACKGROUND: We evaluated the analgesic efficacy of a 5% eutectic mixture of lidocaine and prilocaine (EMLA(R)) topically applied before performing skin puncture for spinal or epidural anesthesia. METHODS: The patient population consisted of 75 ASA physical status 1 and 2 adults scheduled for operations of the lower abdominal region, the perineal region or the lower extremities. The patients were randomly allocated to one of five groups of equal size: group A - topical application of EMLA(R) cream 120 min before spinal block; group B - subcutaneous infiltrationof 2 ml of 2% lidocaine immediately before spinal block; group C - no pretreatment before spinal block; group D - topical application of EMLA(R) cream 120 min before epidural block; and group E - subcutaneous infiltration of 2 ml of 2% lidocaine immediatelybefore epidural block. Pain experienced during the whole procedure was rated using a 10 cm visual analogue scale. RESULTS: Patients in group A experienced less pain compared with those in groups B and C (2.0 +/- 1.9 cm vs 4.1 +/- 1.9 cm and 3.9 +/- 2.2 cm, respectively; P < 0.05). However there was no significant difference between group D and group E (3.6 +/- 2.4 cm vs 4.1 +/- 2.5 cm). The patients in group A and group D were highly satisfied with the method of analgesia (P < 0.05). CONCLUSIONS: EMLA(R) cream is an effective alternative to subcutaneous infiltration of local anesthetic for analgesia during skin puncture using a 25 G spinal needle. It provides insufficient analgesia however for epidural anesthesia.
Adult ; Analgesia ; Anesthesia, Epidural ; Anesthesia, Spinal ; Benzeneacetamides ; Humans ; Lidocaine ; Lower Extremity ; Needles ; Piperidones ; Prilocaine ; Punctures ; Skin

OBJECTIVE: To assess the analgesic efficacy of compound lidocaine cream in lumbar puncture of children with leukemia and lymphoma. METHODS: 312 leukemia and lymphoma children necessarily undergone lumbar puncture were divided into compound lidocaine cream (cream) group and compound lidocaine injection (injation) group as control with 156 cases respectively according to the will of inpatient children and their family. For cream group, compound lidocaine cream was smeared on the skin around the lumbar puncture point evenly and covered with sterile and transparent dressing for about one hour before lumbar puncture. Then the cream and transparent dressing were removed and lumbar puncture was performed after regular disinfection. For control group, 2% compound lidocaine was injected as local anesthesia before lumbar puncture. The extent of pain was evaluated by Wong-Baker Faces Pain Rating Scale and FLACC Scale as well as children's physiological indexes (heart rate, breathing, blood pressure). The lumbar puncture success rate and the discomfortableness as well as family satisfaction were recorded by special person. RESULTS: Compared with control group, the incidence of pain and discomfortableness in cream group significantly reduced, and the family satisfaction significantly increased (P＜0.05). There were obviously differences in the physiological indexes (heart rate, breathing, systolic blood pressure) before and after lumbar puncture in control group (P＜0.05). However, the physiological indexes in cream group had no obvious change. There was no difference on the success rate of lumbar puncture between the two methods of anesthesia. CONCLUSION Compound lidocaine cream has significantly analgesic effect which can relieving pain caused by lumbar puncture for children.
Analgesics ; Anesthetics, Local ; Child ; Hematologic Neoplasms ; Humans ; Lidocaine ; Lidocaine, Prilocaine Drug Combination ; Spinal Puncture

BACKGROUND AND OBJECTIVES: adial artery spasm is one of the most common complications of transradial coronary angiography (TRA): the radial artery is prone to cathecholamine-induced contraction and radial pain during TRA could increase the sympathetic tone. The object of this study was to evaluate whether the eutectic mixture of local anesthesia (EMLA) cream, in addition to lidocaine infiltration, could reduce the sympathetic response by reducing radial pain during TRA. SUBJECTS AND METHODS: Seventy-six patients were randomized 1 : 1 to either EMLA or control groups. Radial pain was measured by the visual analogue scale (VAS) and the verbal rating scale (VRS-4). Sympathetic response, including systolic (SBP) and diastolic blood pressure (DBP), pulse rate (PR), stroke volume (SV) and total peripheral resistance (TPR), was measured by photoplethysmography. RESULTS: Radial pain measured during lidocaine infiltration was significantly lower in the EMLA group (VAS: 3.1 vs. 4.0, p=0.04; VRS-4: 2.0 vs. 2.2, p=0.03) and the sympathetic response was significantly blunted in the EMLA group from baseline to lidocaine infiltration (DeltaSBP, mm Hg: 5 vs. 13, p<0.01; DeltaDBP, mm Hg: 2 vs. 7, p=0.03; DeltaPR, beat/min: 2 vs. 8, p<0.01, DeltaSV, mL: 3 vs. 21, p<0.01; DeltaTPR, mm Hg . L/min: 1.0 vs. 5.9, p<0.01). CONCLUSION: In patients undergoing TRA, the EMLA cream, in addition to lidocaine infiltration, effectively reduces the radial pain and thereby the sympathetic response, during lidocaine infiltration.
Anesthesia, Local ; Arteries ; Blood Pressure ; Contracts ; Coronary Angiography ; Heart Rate ; Humans ; Lidocaine ; Prilocaine ; Radial Artery ; Spasm ; Stroke Volume ; Vascular Resistance

PURPOSE: Frey's syndrome is a common complication after parotid surgery and characterized by gustatory sweating and flushing in the periauricular area during meals. Although a variety of methods were proposed to prevent this postoperative problem, they were unsatisfactory. We used botulinum toxin A to treat 9 patients with Frey's syndrome and investigated the duration effect after the injection. METHODS: Nine patients became the object of study about the effect of botulinum toxins as treatment of Frey's syndrome. Age of patients ranged from 25 to 78 years (mean, 43.7 years). Six of nine patients had both symptoms of gustatory sweating and flushing. And the others had only gustatory sweating symptom. Using Minor starch iodine test, the affected skin area was detected, and it was marked by 1 cm2 sized grid appearance. After application of EMLA cream on the gustatory sweating area, botulinum toxin A was injected intracutaneously into the affected skin area (2.5 U/cm2). Patients were followed up from six to fifteen months (mean, about 12 months) and asked about improvement of their symptoms. RESULTS: The treatment with botulinum toxin A had an effect within 2 days after the injection. Six months after injection, gustatory sweating disappeared completely in all patients, and 5 of six patients who had gustatory flushing improved in their symptom. At the last follow-up, no patients complained of recurrent gustatory sweating and flushing except one. One patient, seven months after initial injection, was retreated with botulinum toxin A because of recurrence, and the result was successful. The duration of the effect after botulinum toxin A treatment was ranged from seven to thirteen months. One patient in our series experienced the upper eyelid weakness as adverse effect, but it improved spontaneously. CONCLUSION: Local injection of botulinum toxin A is an effective, safe and long-lasting method for treatment of Frey's syndrome. Hereafter, however, additional study is required to evaluate the duration effect of botulinum toxin A as to frequency in use and dosage
Botulinum Toxins ; Eyelids ; Flushing ; Follow-Up Studies ; Humans ; Iodine ; Lidocaine ; Meals ; Prilocaine ; Recurrence ; Skin ; Starch ; Sweating, Gustatory

PURPOSE: The purpose of this study was to identify the effects of EMLA cream (eutectic mixture of local anesthetics, lidocaine and prilocaine) on pain during ampicillin sodium intradermal (ID) skin test, and also to assess skin reaction after the skin test. METHODS: Forty-three nurse-volunteers had skin tests with 0.01ml-0.05ml ampicillin sodium antibiotics. Skin tests were done on each forearm to compare the pain level of the skin test site after application of EMLA cream with the pain level when no EMLA cream was applied. EMLA cream was applied at the ID skin test site with an occlusive dressing for one hour. Pain was evaluated using a visual analogue scale and pain sensation using the short form McGill Pain Questionnaire. The transverse diameter of the wheal and redness was read right after and at 15 minutes after the skin test. The results were compared using independent t-tests. RESULTS: Pain score and sensation with EMLA cream treatment were significantly lower than when EMLA cream was not applied. There was no difference in skin reactions; reading of the skin test was not affected by EMLA cream. CONCLUSIONS: EMLA cream was found to be an effective local anesthetic to relieve the pain of clients having ampicillin sodium antibiotics ID skin tests.
Ampicillin ; Anesthetics, Local ; Anti-Bacterial Agents ; Forearm ; Intradermal Tests ; Lidocaine ; Occlusive Dressings ; Pain Measurement ; Prilocaine ; Sensation ; Skin ; Skin Tests

BACKGROUND: Capsicum frutescens or 'siling labuyo' is known for its nutritional and pharmacological properties. Its most potent and predominant chemical entity is capsaicin. A recent study on rabbits concluded that 'siling labuyo' fruit extract is comparable to a topical local anesthetic medication containing lidocaine and prilocaine as an anesthetic agent.
OBJECTIVES: This study aimed to determine the efficacy and safety of capsaicin ointment as a topical anesthetic agent in comparison with a topical local anesthetic cream (eutectic mixture of lidocaine and prilocaine) and placebo ointment in healthy human volunteers.
METHODS: A patch test was done prior to clinical testing. Thirty (30) healthy adult volunteers were enrolled. Irritation potential of 50% and 75% ointments were determined. On the clinical trial phase, 85 patients were included. The following test drugs were used: 50% capsaicin ointment, 75% capsaicin ointment, eutectic mixture of 2.5% lidocaine and 2.5% prilocaine, and placebo ointment. Allocation of the test drugs to the marked boxes on the patient's forearm was done through simple randomization using a computer-generated random allocation scheme. Both the subjects and the investigators were blinded on the test drugs applied. Test ointments and placebo were applied on the marked areas of the forearms and occluded with a transparent plastic film. After 60 minutes, the investigator recorded any adverse reactions. The marked areas were then tested for pain sensation using a needle lever apparatus that enabled the sharp point of the needle to thrust uniformly and perpendicularly on the marked test areas. The subjects were asked to assess the pain by a verbal response scale for pain. Adverse reactions were again noted on the 24th and 72nd hour.
RESULTS: In the patch test, the primary irritation index (PII) scores of both 50% and 75% ointments (0.05 and 0.18), were classified as non-irritant and probably safe for intact human skin contact.
In the clinical trial phase, the data were analyzed using Wilcoxon signed ranks test. It established that the positive control (cream containing eutectic mixture of lidocaine and prilocaine) had significantly lower pain scores than 50% and 75% capsaicin ointments and placebo. Capsaicin ointments were no better than placebo in terms of mean pain scores.
CONCLUSION: In humans, 50% and 75% capsaicin ointments are not effective as a topical anesthetic agent as compared to the eutectic mixture of lidocaine and prilocaine. Capsaicin ointment is associated with mild adverse reactions which were described as stinging and itching sensations which were seen in 84.7% of patients.

Human ; Male ; Female ; Adult ; Anesthesia, Local ; Anesthetics, Local ; Capsaicin ; Capsicum ; Forearm ; Healthy Volunteers ; Lidocaine ; Ointments ; Pain ; Patch Tests ; Prilocaine ; Pruritus

To elucidate the molecular mechanism of pharmacological action of local anesthetics, we studied membrane actions of tetracaine, bupivacaine, lidocaine, prilocaine and procaine. Fluorescence polarization of n- (9-anthroyloxy) stearic acid (n-AS) was used to examine the effects of these local anesthetics on differential rotational mobility of different positions of the number of synaptosomal plasma membrane vesicle (SPMV) phospholipid carbon atoms. The four membrane components differed with respect to 3, 6, 9 and 16- (9-anthroyloxy) stearic acid (3-AS, 6-AS, 9-AS and 16-AP) probes, indicating that differences in the membrane fluidity might be present. Degrees of the rotational mobility of 3-AS, 6-AS, 9-AS and 16-AP were different depending on depth of hydrocarbon interior. In a dose-dependent manner, tetracaine, bupivacaine, lidocaine, prilocaine and procaine decreased anisotropy of 3-AS, 6-AS, 9-AS and 16-AP in the hydrocarbon interior of the SPMV. These results indicate that local anesthetics have significant disordering effects on hydrocarbon interior of the SPMV, thus affecting the transport of Na+ and K+ in nerve membranes and leading to anesthetic action.
Anesthetics, Local* ; Anisotropy ; Bupivacaine ; Carbon ; Cell Membrane ; Fluorescence Polarization ; Lidocaine ; Membrane Fluidity ; Membranes* ; Neurons* ; Prilocaine ; Procaine ; Tetracaine

OBJECTIVES: To investigate the effects of topical anesthetic ointment (lidocaine 2.5% prilocaine 2.5%) to the pain during electromyographic examination. METHOD: Thirty-two adults without known neurological disorders were studied. The needle Electromyography (EMG) of flexor carpi radialis (FCR) muscle and the motor and sensory conduction studies of median nerve were performed after the application of topical anesthetic ointment in one upper extremity and compared to the other side upper extremity without anesthesia. The intensity of pain was assessed with the Visual Analog Scale (VAS) and the characteristics of pain was evaluated with the modified short-form McGill pain questionnaire. RESULTS: The VAS score of the needle EMG of FCR muscle in the anesthetized side was significantly lower to that of the non-anesthetized side (P<0.01). And the characteristics of pain were shooting (10 cases, 31.3%), or throbbing (6 cases, 18.8%) in the anesthetized side and dull (13 cases, 40.6%), or numb (7 cases, 21.9%) in the non-anesthetized side. The VAS scores of the sensory and motor nerve conduction study of median nerve were not significantly different in both sides. CONCLUSION: The application of topical anesthetic ointment decreases the intensity and changes the characteristics of pain during the needle EMG.
Adult ; Anesthesia ; Electromyography ; Humans ; Median Nerve ; Needles ; Nervous System Diseases ; Neural Conduction ; Pain Measurement ; Prilocaine ; Upper Extremity ; Visual Analog Scale