Korean J Anesthesiol.  2008 Apr;54(4):395-399. 10.4097/kjae.2008.54.4.395.

The Analgesic Efficacy of a 5% Eutectic Mixture of Lidocaine and Prilocaine Prior to Insertion of Spinal and Epidural Block

• Kim YJ
• Jung MH
• Choi YR
• Park HJ
• Won RS
• Lee JY
• Jung JK

• KMID: 1763270
• DOI: http://doi.org/10.4097/kjae.2008.54.4.395

Abstract

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.

Keyword

epidural anesthesia; eutectic mixture of lidocaine and prilocaine; infiltration; lidocaine; spinal anesthesia

MeSH Terms

Adult
Analgesia
Anesthesia, Epidural
Anesthesia, Spinal
Benzeneacetamides
Humans
Lidocaine
Lower Extremity
Needles
Piperidones
Prilocaine
Punctures
Skin
Benzeneacetamides
Lidocaine
Piperidones
Prilocaine