Comparison the Efficacy of EMLA Cream versus EMLA with High Frequency Sonophoresis in Decreasing Onset Time to Topical Anaesthesia in Adult Volunteers: A Pilot Study

Background: Sonophoresis or phonophoresis is a well-known transdermal drug delivery mechanism. Usage of high frequency ultrasound for sonophoresis was initiated in late 1950s while the usage of low-frequency sonophoresis was investigated significantly during the past two decades. The objective was to analyze the efficacy of high frequency ultrasound probe in the penetration of EMLA cream in decreasing onset time for topical anaesthesia in adult healthy volunteers. Methods: A prospective, open labelled, comparative study was conducted on patients reporting at the Pain Clinic our institute. Subjects received the intervention USG probe with EMLA either on the left or the right hand based on a random number chart, with the other hand of the same subject acting as a control. In group USG, the probe was applied directly on the cream without any added pressure. Sensory testing was done every 10 minutes by pin prick on both the hands of the patients NRS scores of both the hands were recorded at 10.20,30 and 40 minutes. Results: Total 20 patients were selected for the study. Although a significant decrease in the pain scores in both the groups was observed after 40minutes, (p<0.05) both the groups are comparable at each point of time. We could not find any significant decrease in pain scores when groups are compared in intervals during the study period. Conclusion: There is no significant difference in decreasing the intensity of pain scores upon application of ultrasound over EMLA in an adult population. Further studies have to be done to prove the efficacy in a larger population and pediatric ones.

Evaluation of eutectic lidocaine/prilocaine cream for jugular blood sampling in cats

Objectives The study aimed to evaluate the efficacy of a eutectic lidocaine/prilocaine cream (EMLA cream; Astra Pharmaceuticals) in reducing pain and reaction to venepuncture during jugular blood sampling in cats after a 30-min topical application time. Methods The study was a prospective, blind, controlled clinical trial. Eighteen healthy client-owned cats were randomly allocated to two study groups. All cats were clipped on the left jugular groove region and then, depending on the study group, either the placebo (liquid paraffin) or EMLA cream was applied to the region. The area was then kept protected for the next 30 mins. Except for the operator who administered the product, all operators were blinded to the study groups. Blood sampling was performed by an experienced operator and a stress score was assigned to each cat according to the reactions observed during the venepuncture. Also, the procedure was classified as being ‘easy’ or ‘difficult’ by the same operator. Results A significantly reduced stress score was observed in cats that received the EMLA cream compared with those belonging to the placebo group ( P = 0.048); withdrawal movements were observed in 1/9 cats treated with the EMLA cream vs 7/9 cats of the placebo group ( P = 0.015). The jugular venepuncture was defined as easy in 1/9 cats that received the placebo and in 8/9 cats in the EMLA group ( P = 0.015). Conclusions and relevance The present study provides evidence for the efficacy of the EMLA cream after a 30-min application time for jugular venepuncture in cats, together with significantly reduced stress for patients. Therefore, this study supports the routine use of EMLA cream as good practice to enhance the welfare of cats and to simplify venepuncture procedures.

EMLA- AN EFFECTIVE TOOL FOR TOPICAL ANALGESIA IN SPLIT SKIN GRAFT HARVEST

Background: Many patients require general anesthesia merely for skin grafting. EMLA cream which is aeutectic mixture of Lignocaine and Prilocaine provides surface anesthesia when applied on intact skin. Its role in venepuncture or IV cannula insertion in children is well documented. Aim and Objective: To compare effectiveness of EMLA over inltrative local anaesthesia in split skin graft harvest. Method: A prospective study was conducted on 64 patients who required skin grafting. Various indications for grafting were noted. The patients were randomly allocated to two groups. In one group 32 patients, graft was harvested after application of EMLA cream whereas in another group of 32 patients, graft was harvested by inltrating local anesthesia. Pain perceived during donor area preparation, graft harvesting and post-operative pain was recorded and compared between the two groups on Visual analogue scale and Likert scale. Results: Total 64 patients were included in the study with 32 patients in either group. Traumatic loss of skin was the most common indication in either group for skin graft harvest. As per visual analogue scale during the graft harvest, most of the patients were in the range of 4-7 score in either group (71.87% vs 53.12%). 75% of the patients were in the 4-7 score in both groups. As per likert scale during the graft harvest score of 4 was noted in 62.5% in group 1 vs 53.12% in group 2 patients. 81.25% patients in group 1 reported procedure as excellent versus 53.12% patients in group 2. Patients experienced more pain during inltration of local anesthesia. Whereas more bleeding was noted in EMLA group immediately after harvest of graft. Conclusions: EMLA cream can be effectively used as an alternative to local anaesthetic inltration for harvest of split thickness skin graft