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: Although regional anesthesia is the first choice for patients undergoing total knee arthroplasty (TKA), it may not be effective and the risk of complications is greater in patients who are obese or who have spinal deformities. We compared the success of ultrasound-guided femoral and sciatic nerve blocks with sedoanalgesia versus spinal anesthesia in unilateral TKA patients in whom spinal anesthesia was difficult. METHODS: We enrolled 30 patients; 15 for whom spinal anesthesia was expected to be difficult were classified as the block group, and 15 received spinal anesthesia. Regional anesthesia was achieved with bupivacaine 62.5 mg and prilocaine 250 mg to the sciatic nerve, and bupivacaine 37.5 mg and prilocaine 150 mg to the femoral nerve. Bupivacaine 20 mg was administered to induce spinal anesthesia. Hemodynamic parameters, pain and sedation scores, and surgical and patient satisfaction were compared. RESULTS: A sufficient block could not be obtained in three patients in the block group. The arterial pressure was significantly lower in the spinal group (P < 0.001), and the incidence of nausea was higher (P = 0.017) in this group. Saturation and patient satisfaction were lower in the block group (P < 0.028), while the numerical pain score (P < 0.046) and the Ramsay sedation score were higher (P = 0.007). CONCLUSIONS: Ultrasound-guided sciatic and femoral nerve blocks combined with sedoanalgesia were an alternative anesthesia method in selected TKA patients.
Anesthesia ; Anesthesia, Conduction ; Anesthesia, Spinal* ; Arterial Pressure ; Arthroplasty* ; Bupivacaine ; Congenital Abnormalities ; Femoral Nerve ; Hemodynamics ; Humans ; Incidence ; Knee* ; Nausea ; Nerve Block ; Patient Satisfaction ; Prilocaine ; Sciatic Nerve* ; Ultrasonography

INTRODUCTIONCryotherapy with liquid nitrogen is an effective, safe and convenient form of treatment for plantar warts. EMLA® cream (eutectic mixture of lidocaine 2.5% and prilocaine 2.5%) is a topical local anaesthetic agent that has proven to be effective and well tolerated in the relief of pain associated with various minor interventions in numerous clinical settings.

MATERIALS AND METHODSIn a single-centre, double-blind, randomised placebo-controlled study, 64 subjects were randomised into 2 groups. The subjects had a thick layer of EMLA® cream or placebo cream applied to pared plantar wart(s) and onto the surrounding margin of 1 mm to 2 mm under occlusion for 60 minutes prior to receiving cryotherapy. The pain of cryotherapy was evaluated by the subjects using a self-administered Visual Analogue Scale (VAS) immediately after the cryotherapy.

RESULTSThere was no statistical difference between the mean VAS score for EMLA® cream (47.0 ± 21.4 mm) and placebo (48.9 ± 22.0 mm). Those with more than 1 wart had a significantly higher VAS score than those with only 1 wart (59.1 ± 21.8 vs. 44.3 ± 20.4, P <0.05) but this did not affect the therapeutic effect of EMLA® cream prior to cryotherapy.

CONCLUSIONWe conclude that the application of EMLA® cream prior to cryotherapy does not reduce the pain associated with cryotherapy.

Adult ; Analgesia ; Anesthetics, Local ; therapeutic use ; Cryotherapy ; Double-Blind Method ; Female ; Foot Dermatoses ; therapy ; Humans ; Lidocaine ; therapeutic use ; Male ; Middle Aged ; Ointments ; Prilocaine ; therapeutic use ; Warts ; therapy ; Young Adult

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

PURPOSE: Transrectal ultrasound-guided prostate biopsy is the procedure of choice for diagnosing prostate cancer. We compared with pain-relieving effect of acetaminophen, a known drug for enhancing the pain-relieving effect of tramadol, and eutectic mixture of local anesthetics (EMLA), a local anesthetic agent, with that of the conventional periprostatic nerve block method. MATERIALS AND METHODS: This was a prospective, randomized, single-blinded study. A total of 430 patients were randomly assigned to three groups. Group 1 received a periprostatic nerve block with 1% lidocaine, group 2 received acetaminophen 650 mg, and group 3 received EMLA cream for pain control. All patients were given 50 mg of tramadol intravenously 30 minutes before the procedure. At 3 hours after completion of the procedure, the patients were asked to grade their pain on a horizontal visual analogue scale (VAS). The patients were also asked whether they were willing to undergo future biopsy if required. RESULTS: There were no significant differences between the three groups in terms of age, prostate-specific antigen, prostate size, or numbers of biopsy cores. The pain scores for groups 2 and group 3, which were 3.47+/-1.92 and 3.50+/-1.36, respectively, were similar and were significantly lower than that of group 1, which was 5.24+/-2.07. CONCLUSIONS: Acetaminophen and EMLA cream with intravenous injection of tramadol are safe, easy, and effective methods of controlling pain during the procedure. These methods were more effective for pain relief than was the conventional periprostatic nerve block method.
Acetaminophen ; Administration, Oral ; Anesthetics, Local ; Biopsy ; Biopsy, Needle ; Humans ; Injections, Intravenous ; Lidocaine ; Nerve Block ; Prilocaine ; Prospective Studies ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Tramadol

PURPOSE: The purpose of this study is to prove the effects of topical anesthetics (EMLA) to control pain in preterm infants during invasive procedure (percutaneous central venous catheterization, PCVC). METHODS: A total of 18 preterm infants of birth weight <2,000 g and gestational age <36 weeks born at EulJi University Hospital, at Daejeon in 2010 were randomly included in this study. EMLA was applied in nine preterm infants 40 minutes before starting PCVC and placebo was applied in another nine preterm infants. Based on PIPP (preterm infant pain profile), we evaluated their heart rate, oxygen saturation before, 15 seconds during and 30 seconds after procedure. Behavioral responses were also recorded for 2 minutes after procedure. RESULTS: Experimental group showed significantly less behavioral response during procedure (P=0.005) and 2 min after procedure (P=0.001). Also, experimental group showed less increase in heart rate (P=0.033) and reduction of behavioral state (P=0.017). CONCLUSION: Despite limitation of small size in this study, experimental group showed lower pain score compared with placebo control group during catheterization. In neonatal care unit (NICU), we recommend the use of topical anesthetics such as EMLA to control pain during invasive procedures.
Anesthetics ; Birth Weight ; Catheterization ; Catheterization, Central Venous ; Catheters ; Central Venous Catheters ; Gestational Age ; Heart Rate ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Lidocaine ; Oxygen ; Prilocaine

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 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: 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

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