Jemds.com Original Article J. Evolution Med. Dent. Sci./eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 5/ Issue 38/ May 12, 2016 Page 2314 EVALUATION OF THE EFFECTIVENESS OF TOPICAL EMLA CREAM AS LOCAL ANAESTHETIC IN VENEPUNCTURE Bodicherla Siva Kumar 1 , Sampathi Shiva Krishna 2 , Adil Hasan 3 1 Assistant Professor, Department of Anaesthesia, Malla Reddy Institute of Medical Sciences, Hyderabad. 2 Senior Resident, Government Medical College, Nizamabad. 3 Senior Resident, Department of Anaesthesia, Kamineni Institute of Medical Sciences, Narketpally. ABSTRACT BACKGROUND AND OBJECTIVES The efficacy of a topical anaesthetic formulation, EMLA 5% cream (Eutectic Mixture of Local Anaesthetics) in obtunding the pain produced by intravenous cannulation was determined in our study. This study aims at evaluating the efficacy of EMLA cream in producing dermal analgesia for venous cannulation and the effect of timing of application of EMLA cream prior to cannulation. MATERIALS AND METHODS Amongst 60 patients, EMLA cream was applied for 60 minutes in 20 patients, 30 minutes in another 20 and in the remaining 20 no cream or placebo was applied. RESULTS Pain was assessed in all the groups by a 4-point rank score. It was found that patients with EMLA cream had lower pain scores and decreased haemodynamic stress response to venous cannulation when compared to the control group. INTERPRETATION AND CONCLUSION Maximum analgesia was observed in patients who had EMLA cream applied for 60 minutes. No significant side effects were seen with this formulation. KEYWORDS EMLA Cream, Venous Cannulation, Pain Score. HOW TO CITE THIS ARTICLE: Kumar BS, Krishna SS, Hasan A. Evaluation of the effectiveness of topical EMLA cream as local anaesthetic in venepuncture. J. Evolution Med. Dent. Sci. 2016;5(38):2314-2318, DOI: 10.14260/jemds/2016/538 INTRODUCTION One of the most important pre-requisites of delivering anaesthesia to any patient is securing a safe and patent intravenous access for drug and fluid administration. Intravenous cannulation is now performed almost universally before induction of anaesthesia. 1 Superficial venous puncture in adults is performed currently without anaesthesia, as it is considered to be a less traumatic experience for them when compared to children. However, this procedure has been reported to produce significant pain. 2 and therefore the use of percutaneous anaesthetic agents may be appropriate. The needle prick can also make a patient uncooperative and the anxiety caused can result in an haemodynamic stress response leading to increase in heart rate and blood pressure of the patient. 3 Many attempts have been made to produce local analgesia and to allow painless venepuncture by the topical application of various drugs. Topical 4% lignocaine or 20% benzocaine have been employed but their use has been limited by concerns about local irritation, systemic toxicity and inadequate analgesia. 4 Financial or Other, Competing Interest: None. Submission 01-04-2016, Peer Review 23-04-2016, Acceptance 29-04-2016, Published 12-05-2016. Corresponding Author: Bodicherla Siva Kumar, Assistant Professor, Department of Anaesthesia, Malla Reddy Institute of Medical Sciences, Suraram Main Road, Hyderabad-500055. E-mail: avis_dr@yahoo.com DOI: 10.14260/jemds/2016/538 Other methods like use of ethyl chloride spray. 5 lignocaine iontophoresis. 6 and topical application of Ibuprofen. 7 have been described, but each one has certain drawbacks. The relative ineffectiveness of various transfer preparations have been attributed either to insufficient concentration of uncharged base of the anaesthetic product or to poor skin absorption. With the advent of Eutectic Mixture of Local Anaesthetics (EMLA) cream, effective topical analgesia of intact skin is now claimed to be feasible without the need for subcutaneous injections or exposure to high concentrations of local anaesthetics. 8 EMLA cream is a 1:1% oil in water emulsion of 2.5% lignocaine and 2.5% prilocaine bases. This mixture is termed eutectic, as it has a melting point lower than its individual components. This mixture is liquid at room temperature, while individual components are crystalline substances. 9 AIM This study aims at evaluating the efficacy of EMLA cream in producing dermal analgesia for venous cannulation and the effect of timing of application of EMLA cream prior to cannulation. MATERIALS AND METHODS A total of 60 inpatients posted for elective surgeries belonging to ASA grade I and grade II were selected. The patients belonged to either sex and were of the age group 18 to 60 years. The study was conducted in Malla Reddy Institute of Medical Sciences, Hyderabad, over a period of one year.