Anesth Pain Med.  2024 Jul;19(3):233-240. 10.17085/apm.23136.

Comparison of 2% lidocaine infiltration and eutectic mixture of local anesthetics cream application before spinal needle insertion for pain reduction and assessment of maternal satisfaction levels in women undergoing cesarean section at a tertiary care setup in Pakistan: a randomized controlled trial

• Hameed M
• Khan S

• KMID: 2563563
• DOI: http://doi.org/10.17085/apm.23136

Abstract

Background
This study aimed to compare two analgesic pretreatment techniques for assessing pain reduction before spinal needle insertion and the subsequent patient satisfaction levels in pregnant female patients undergoing cesarean sections.
Methods
Sixty pregnant female patients scheduled for elective cesarean section under spinal anesthesia were randomly assigned to two groups. The Lidocaine group received local skin infiltration with 2% lidocaine pretreatment before spinal needle introducer insertion, whereas the eutectic mixture of local anesthetics (EMLA) group received EMLA (lidocaine 2.5% and prilocaine 2.5%) cream pretreatment for at least 30 min before spinal needle introducer insertion. Subjective and objective pain scores, procedure duration, number of attempts, maternal satisfaction, and decisions regarding future numbing procedures and regional anesthesia were assessed.
Results
The demographic characteristics of the patients were similar between groups. The mean visual analogue scale pain score was significantly lower in the EMLA group compared to the lidocaine group (P < 0.05). Additionally, the objective pain score was significantly lower in the EMLA group (P < 0.05). The duration of spinal block placement was significantly longer in the lidocaine group than in the EMLA group (P < 0.05). The number of attempts to perform the spinal block placement was similar in both groups. However, women in the EMLA group expressed greater overall satisfaction than those in the lidocaine group (76.7% vs. 20.0%, P < 0.05).
Conclusions
Analgesic pretreatment with EMLA cream is superior to local skin infiltration with lidocaine in pregnant patients undergoing elective cesarean section under spinal anesthesia.

Keyword

Pregnancy; Lidocaine; Anesthetics, local; Cesarean section; Analgesics; Lidocaine, prilocaine drug combination; Anesthesia, Spinal

Figure

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  Fig. 1. Diagram classifying the flow of the study participants through each stage of the randomized trial. CONSORT: Consolidated Standards of Reporting Trials, BMI: body mass index.

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  Fig. 2. Comparison of mean VAS pain score between groups. VAS: visual analogue scale, EMLA: eutectic mixture of local anesthetics, CI: confidence interval.

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  Fig. 3. Comparison of objective pain in term of intensity between groups. EMLA: eutectic mixture of local anesthetics.

Reference

1. Matthey PW, Finegan BA, Finucane BT. The public's fears about and perceptions of regional anesthesia. Reg Anesth Pain Med. 2004; 29:96–101.

2. Massoth C, Weidlich S, Pöpping D, Gurlit S, Möllmann M. Effects of local skin anaesthesia on pain during lumbar puncture. J Anaesthesiol Crit Care. 2017; 1:1–5.

3. Lugo‐Janer G, Padial M, Sánchez JL. Less painful alternatives for local anesthesia. J Dermatol Surg Oncol. 1993; 19:237–40.

4. Halperin DL, Koren G, Attias D, Pellegrini E, Greenberg ML, Wyss M. Topical skin anesthesia for venous, subcutaneous drug reservoir and lumbar punctures in children. Pediatrics. 1989; 84:281–4.

5. Jiménez JCJ, Oliveras M, Hidalgo E, Cabañas MJ, Barroso C, Moraga FA, et al. Anesthetic efficacy of eutectic prilocaine-lidocaine cream in pediatric oncology patients undergoing lumbar puncture. Ann Pharmacother. 1996; 30:1235–7.

6. Koscielniak‐Nielsen Z, Hesselbjerg L, Brushøj J, Jensen MB, Pedersen HS. EMLA patch for spinal puncture.A comparison of EMLA patch with lignocaine infiltration and placebo patch. Anaesthesia. 1998; 53:1218–22.

7. Sharma SK, Gajraj NM, Sidawi JE, Lowe K. EMLA cream effectively reduces the pain of spinal needle insertion. Reg Anesth. 1996; 21:561–4.

8. Kim YJ, Jung MH, Choi YR, Park HJ, Won RS, Lee JY, et al. The analgesic eEfficacy of a 5% eutectic mixture of lidocaine and prilocaine prior to insertion of spinal and epidural block. Korean J Anesthesiol. 2008; 54:395–9.

9. Lee AM, Lam SK, Lau SMSM, Chong CSY, Chui HW, Fong DYT. Prevalence, course, and risk factors for antenatal anxiety and depression. Obstet Gynecol. 2007; 110:1102–12.

10. Taenzer P, Melzack R, Jeans ME. Influence of psychological factors on postoperative pain, mood and analgesic requirements. Pain. 1986; 24:331–42.

11. Goel S, Chang B, Bhan K, El-Hindy N, Kolli S. “Cryoanalgesic preparation" before local anaesthetic injection for lid surgery. Orbit. 2006; 25:107–10.

12. Riley ET. Regional anesthesia for cesarean section. Tech Reg Anesth Pain Manag. 2003; 7:204–12.

13. Royal College of Anaesthetist. Technique of anaesthesia for Cesarean section. Raising the standard: a compendium of audit recipes. 3rd ed. In : Colvin JR, Peden CJ, editors. Technique of anaesthesia for Cesarean section. London: The Royal College of Anaesthetists;2012. p. 411.

14. Gajraj NM, Sharma SK, Souter AJ, Pole Y, Sidawi JE. A survey of obstetric patients who refuse regional anaesthesia. Anaesthesia. 1995; 50:740–1.

15. Hu P, Harmon D, Frizelle H. Patient comfort during regional anesthesia. J Clin Anesth. 2007; 19:67–74.

16. Abdallah R, Steyn PP, Kamel I. Factors influencing the perception of pain in pregnancy. Pain: A Review Guide. In : Abd-Elsayed A, editor. Switzerland: Springer;2019. p. 989–92.

17. Giordano J, Abramson K, Boswell MV. Pain assessment: subjectivity, objectivity, and the use of neurotechnology part one: practical and ethical Issues. Pain Physician. 2010; 13:305–15.

18. Joly LM, Spaulding C, Monchi M, Ali OS, Weber S, Benhamou D. Topical lidocaine-prilocaine cream (EMLA) versus local infiltration anesthesia for radial artery cannulation. Anesth Analg. 1998; 87:403–6.

19. Holmes HS. Choosing a local anesthetic. Dermatol Clin. 1994; 12:817–23.

20. Bjerring P, Arendt-Nielsen L. Depth and duration of skin analgesia to needle insertion after topical application of EMLA cream. Br J Anaesth. 1990; 64:173–7.

21. Rhee WJ, Chung CJ, Lim YH, Lee KH, Lee SC. Factors in patient dissatisfaction and refusal regarding spinal anesthesia. Korean J Anesthesiol. 2010; 59:260–4.

22. Ismail S, Hameed M. Evaluating anesthesia practice for cesarean section: a prospective cross-sectional study from a tertiary care institution of low- and middle-income country. J Obstet Anaesth Crit Care. 2021; 11:20–4.