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Purpose: The goal of the present study was to evaluate in adults the benefit of the Eutectic Mixture of Local Anesthetics (EMLA®) for preoperative autologous blood donation. Methods: Twenty-six adult patients requiring three blood samples were studied. The pain of venipuncture was assessed by the patient using a 100 mm Visual Analogue Scale (VAS) and a four-category Verbal Rating Scale (VRS). The first puncture was performed without anaesthesia, as a “reference puncture.” The second and third punctures were performed with EMLA® and placebo in a double-blind cross-over randomization. For statistical analysis, the patients were allocated to two groups according to the VAS scores of the reference puncture: (Group 1) VASref< 20 mm; (Group 2) VASref≥20 mm. Results: For the whole 26 patients, the VAS and the VRS pain scores were lower for EMLA® puncture than for both the placebo and reference punctures (P < 0.05). Twenty patients had a VASref< 20 mm and six patients a VASref≥ 20 mm. In Group 1, there was no difference between EMLA® and placebo for both the VAS and VRS scores. In contrast, in Group 2, the VAS score was lower for EMLA® than for both the placebo and the reference punctures (respectively 11 ± 7.1, 28.9 ±7.9, 29.1 ± 6.4; P < 0.01); the VRS score was also lower for EMLA® puncture than for placebo puncture (P < 0.05). Conclusion: In adults requiring repeated venous punctures, pain from cannulation may be evaluated at the first puncture with a Visual Analogue Scale, thus indicating or not the need for EMLA®.

The aim of this prospective study was to evaluate the efficacy of two dosage regimens of (im) morphine calculated from an initial (iv) titrated dose in the early postoperative period. Seventy ASA I–III patients who underwent general anaesthesia (GA) (n = 58), regional anaesthesia (RA) (n = 10) or GA + RA (n = 2) for orthopaedic (n = 54), urological (n = 11) or abdominal surgery (n = 5) received iv titrated morphine in the post-anaesthesia care unit (PACU). Titration consisted of 3 mg morphine iv every ten minutes until patients had a visual analogue pain scale (VAS) <3, without marked sedation. Seventeen patients did not complain at all or had good analgesia with an initial iv dose ≤6 mg of morphine followed by paracetamol only. Patients who needed more than 6 mg iv morphine were randomly assigned to a “high-dose” or a “low-dose” group and received a systematic im morphine regimen calculated from the initial titrated dose. Pain was assessed by VAS before each im injection and the next morning. One patient had respiratory depression and one marked sedation in the PACU. These patients were excluded from the rest of the study. Only 16 patients had a VAS >3 at least once during the study period and only three needed rescue analgesia which was available on request. We conclude that a systematic im morphine regimen adapted from an initial iv titration in the PACU provides efficacious and relatively inexpensive postoperative analgesia, applicable to a great majority of patients.