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Background: Prior literature highlights the importance of local anesthesia (LA) for stainless steel crown (SSC) preparation and placement. Nevertheless, the effectiveness of a eutectic mixture of local anesthesia (EMLA), a topical anesthesia, for this purpose remains unexplored. Aim: The study evaluated the effectiveness of two EMLA application methods during SSC preparation and placement. Design: Eighty‐four children between 4 and 8 years of age were randomly allocated to three intervention groups. Group A received EMLA applied supragingivally, Group B received a gingival retraction cord impregnated with EMLA (GRC_EMLA), and Group C (control) received LA. Pain was recorded using Wong–Baker Faces Pain Scale (WBFPS) and Children Hospital Eastern Ontario Pain Scale (CHEOPS) at three time intervals. Results: Control had highest mean pain scores at the first time interval in both maxillary and mandibular arches, followed by Group B and Group A, with statistically significant p‐values (p =.00, p <.05). After preparation and placement, all three groups had low mean pain scores, with no statistically significant differences. Group A had minimal pain scores at all three time intervals, although not statistically significant. Conclusion: EMLA is a potent topical anesthetic and can be used as an alternative to LA for conventional SSC preparation and placement in primary molars. [ABSTRACT FROM AUTHOR]

We systematically investigated the efficacy and safety of EMLA (5% lidocaine–prilocaine cream) versus placebo for pain relief among infertile patients undergoing hysterosalpingography (HSG). We screened four databases from inception until 25 November 2020. We included only randomised placebo-controlled trials (RCTs) and assessed their risk of bias. The main efficacy outcomes included safety and pain scores during the different stages of HSG. The pooled outcomes were summarised as mean difference (MD) with 95% confidence interval (CI). Three RCTs were included, comprising 258 patients (131 and 127 patients received EMLA and placebo, respectively). All RCTs revealed an overall low risk of bias. EMLA significantly reduced pain perception during cervical instrumentation of tenaculum and cannula (MD = −1.53, 95% CI [−2.59, −0.47], p = 0.005) and at 24 h after completion of HSG (MD = −1.30, 95% CI [−2.57, −0.03], p = 0.04). Despite EMLA decreased pain perception during the other procedural stages of HSG, the differences were not statistically significant compared with placebo. EMLA was safe and free of local and systemic adverse reactions. This meta-analysis advocates that topical application of 5% EMLA cream is safe and correlates with decreased pain perception during HSG, particularly during the cervical instrumentation step and at 24 h after HSG completion. [ABSTRACT FROM AUTHOR]

Background. Pain due to vascular needle insertion has been reported in 40–60% of hemodialysis (HD) patients. Evidence suggests that there is typically no single method for relieving the pain of inserting vascular needles in HD patients. This study aimed to compare the effectiveness of EMLA cream and Valsalva maneuver (VM) on pain severity during vascular needle insertion in HD patients. Methods. This randomized, controlled, clinical trial was conducted on 90 patients undergoing hemodialysis in the hemodialysis unit of Kowsar Hospital, affiliated with Semnan University of Medical Sciences, in Semnan, Iran. Patients were selected via convenience sampling and were randomly assigned to one of the three groups (EMLA, VM, and control groups). For the patients in the EMLA group, 2.5 g of EMLA cream was applied 60 minutes before the start of dialysis. For patients in the VM group, a maneuver was performed for 16–20 seconds before the needle was inserted. Patients in the control group received only routine care without any additional interventions. The pain severity in the three groups was measured using the visual analog scale (VAS) two minutes after vascular needle insertion. Results. The results showed that the mean pain severity during cannulation was 2.06 ± 2.19 in the EMLA group, 3.2 ± 30.42 in the VM group, and 6.20 ± 1.49 in the control group, suggesting a significant difference between the groups (P < 0.001). Pairwise comparison of the mean pain severity showed that it differed significantly in the EMLA and VM groups from the control group (P < 0.001), but no significant difference was found between the EMLA and VM groups (P = 0.067). Conclusion. According to the results, EMLA cream was as effective as VM in reducing the pain severity caused by arteriovenous fistula (AVF) cannulation. Therefore, the use of EMLA cream and VM is recommended for reducing the severity of AVF cannulation pain. Trial Registration. Iranian Registry of Clinical Trials, Trial No : IRCT20120109008665N12, registered on 3 June 2020. [ABSTRACT FROM AUTHOR]

Few studies have evaluated whether topical anesthetic cream reduces pain during pneumococcal vaccination. This is crucial, since effective pain management should be evidence‐based. Previous studies have shown that topical lidocaine‐prilocaine (EMLA®) reduces vaccination‐related pain, measured using pain‐rating instruments and observation of crying time. This intervention study aimed to compare the efficacy of topical lidocaine‐prilocaine cream with that of the standard of care on the expression of pain during the first pneumococcal vaccination administered at age 3 months under the Swedish national vaccination program. A randomized controlled trial included 72 infants receiving their first pneumococcal vaccination (Prevenar 13®). The study showed that topical lidocaine‐prilocaine before pneumococcal vaccination significantly reduced infants' expression of pain according to the Face, Legs, Activity, Cry, Consolability (FLACC) score (P =.006) and increased latency to cry (P =.001). There were no statistically significant differences in the total crying time (P =.146) between the groups. Topical lidocaine‐prilocaine cream reduced pain expression and increased latency to cry in infants receiving their first pneumococcal vaccine. Systematic efforts are needed to successfully implement the use of topical anesthetic cream and other effective non‐pharmacological pain‐relieving strategies during infant vaccination procedures. [ABSTRACT FROM AUTHOR]

Background: Previous researchers have used a 30-min eutectic mixture of local anesthetic (EMLA) test, which assesses the sympathetically mediated vasomotor function, in diagnosing carpal tunnel syndrome (CTS). However, its specificity was low, limiting its clinical diagnostic utility. In this study, we assessed the efficiency of 90-min extended EMLA-induced stimulated skin-wrinkling (SSW) test in CTS diagnosis. Methods: A cross-sectional study was designed among patients clinically diagnosed with CTS. Hands of healthy volunteers and the asymptomatic hands of selected patients served as control. The Boston symptom severity scale (SSS) and the neuropathic pain severity inventory (NPSI) were used to assess symptom severity, and nerve conduction study (NCS) was used to assess electrophysiological severity. EMLA-induced SSW was visually graded after 90 min of application and correlated with symptom and NCS severities. Results: Forty-two symptomatic hands and 30 asymptomatic hands were enrolled as cases and controls, respectively. The diagnostic efficiency of the extended EMLA test was found to be 83.4% for digit 2 and 87.3% for the lateral 4 digits (mean), whereas the diagnostic efficiency of standard NCS was 88.1%. Boston SSS and NPSI were better correlated with EMLA positivity than NCS positivity. A linear regression analysis showed negative correlation of wrinkling grade with NCS grade. Conclusion: With its improved diagnostic efficiency, the 90-min extended EMLA test can feasibly be used as an alternative to NCS, especially in general practice settings. Its potential clinical utility should be explored in a large population of CTS patients showing varying clinical and electrophysiological severities. [ABSTRACT FROM AUTHOR]

Painful procedures are common in the acute care setting, and failing to mange a child's anxiety and pain may have long-term consequences. Being familiar with a diversity of non-pharmacologic and pharmacologic alternatives is critical. [ABSTRACT FROM AUTHOR]

Freeman-Sheldon syndrome is a congenital myopathy with a reported prevalence of less than 1 per 1 million. Also known as craniocarpotarsal dysplasia, this syndrome is characterized by muscle contractures and soft-tissue dysplasia of the face, hands, and feet. The resulting musculoskeletal deformities may require multiple orthopedic, ocular, and plastic reconstructive surgeries. The anesthetic challenges include a potentially difficult airway and intravenous access, suscep- tibility to malignant hyperthermia, and an unpredictable response to muscle relaxants. This report of the anesthetic management of 2 children with Freeman-Sheldon syndrome emphasizes the anesthetic considerations for the successful management of patients with this syndrome. [ABSTRACT FROM AUTHOR]

International Journal of Exercise Science 12(2): 1265-1279, 2019. The purpose of this study was to determine sex differences in the contribution of sensory nerves to rapid cutaneous thermal hyperemia. Healthy young females (n = 15, tested during both the early follicular (EF) and the mid-luteal (ML) phase of the menstrual cycle) and males (n = 15) had a 4 cm2 area of skin on one forearm and one leg treated with a eutectic mixture of local anesthetic (EMLA). EMLA sites, along with corresponding control sites, were instrumented with laser Doppler flowmetry probes and local skin heaters. Baseline (33 °C), rapid and sustained vasodilation (42 °C), and maximal vasodilation (44 °C) skin blood flow data were obtained and expressed as a percentage of maximal cutaneous vascular conductance (%CVCmax). Contribution of sensory nerve involvement was determined by comparing the EMLA site to its matched control site utilizing the formula [(% CVCmax control - % CVCmax treatment) / % CVCmax control] × 100. The contribution of sensory nerves to rapid cutaneous thermal hyperemia in the forearm was 24 ± 18 %CVCmax in males, 41 ± 17 %CVCmax in ML females (p = 0.02 vs. males), and 35 ± 17 %CVCmax in EF females (p > 0.05 vs. males). In the leg, the contribution of sensory nerves was 16 ± 15 %CVCmax in males, 34 ± 17 %CVCmax for ML females (p = 0.02 vs. males), and 28 ± 21 %CVCmax in EF females (p > 0.05 vs. males). ML females exhibited a greater contribution of sensory nerves to rapid cutaneous thermal hyperemia in the forearm and leg, possibly attributed to elevated reproductive hormones during the ML phase. [ABSTRACT FROM AUTHOR]

CONTEXT: The eutectic mixture of lidocaine (EMLA) cream has been used to reduce the pain abstract during venipuncture in infants. OBJECTIVE: To determine the efficacy and safety of EMLA in infants <3 months of age requiring venipuncture in comparison with nonpharmacological interventions in terms of pain reduction, change in physiologic variables, and methemoglobinemia. DATA SOURCES: Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and gray literature were searched from inception to August 2017, without language restrictions. STUDY SELECTION: We selected randomized controlled trials in which researchers compared EMLA with nonpharmacological interventions. DATA EXTRACTION: Two reviewers independently performed abstract screening and full-text review, and extracted the data and assessed the risk of bias. RESULTS: Ten randomized controlled trials (907 infants) were included. EMLA revealed little or no effect in reduction of pain (standardized mean difference: 0.14; 95% confidence interval [CI]: -0.17 to 0.45; 6 trials, n = 742; moderate-quality evidence) when EMLA was compared with sucrose, breastfeeding, or placebo. In comparison with placebo, EMLA revealed a small-to-moderate effect on increasing methemoglobin levels (mean difference: 0.35; 95% CI: 0.04 to 0.66; 2 trials, n = 134; low-quality evidence). There was an increased risk of blanching of the skin in the EMLA group (relative risk: 2.63; 95% CI: 1.58 to 4.38; 2 trials, n = 123; I² = 84%, very low-quality evidence). LIMITATIONS: Our results may not be applicable to older infants. CONCLUSIONS: EMLA reveals minimal benefits in terms of reduction of pain due to venipuncture procedure in comparison with placebo and no benefit in comparison with sucrose and/or breastfeeding. Moreover, it produced an elevation in methemoglobin levels and skin blanching. [ABSTRACT FROM AUTHOR]

Abstract A new strategy for the simple, environmental-friendly and highly-available microextraction of non-steroidal anti-inflammatory drugs (NSAIDs) from human urine samples has been proposed. The procedure assumes NSAIDs separation from aqueous sample phase via in-situ forming deep eutectic mixtures based on the formation of hydrogen bond between OH group of menthol and the oxygen atom of COOH group of NSAIDs. The developed strategy was used for the HPLC-UV determination of ketoprofen and diclofenac in human urine samples. Under optimal experimental conditions limits of detection, calculated from a blank test, based on 3σ were found to be 15 μg L−1 and 44 μg L−1 for ketoprofen and diclofenac, respectively. The microextraction process can reach equilibrium within 1 min with extraction recovery values from 93 to 97% for both analytes. Graphical abstract Unlabelled Image Highlights • New DES-assisted liquid-liquid microextraction approach • Approach coupled with HPLC-UV • Green extraction and HPLC-UV determination of ketoprofen and diclofenac in urine samples • Menthol as selective extractant for NSAIDs [ABSTRACT FROM AUTHOR]

Background: Molluscum contagiosum is a common viral disease seen among the pediatric age group. A wide variety of treatment modalities are available for their management but no therapy is universally effective. Destructive modalities like cryotherapy, extirpation and radiofrequency removal are commonly used but are painful. Aims and Objectives: To evaluate the efficacy of Eutectic Mixture of Local Anesthetics (EMLA) cream versus ice application in alleviation of pain during molluscum contagiosum removal by extirpation. Materials and Methods: In this prospective study, 30 patients underwent molluscum contagiosum removal by needle extirpation. In 15 patients, EMLA cream was applied prior to the procedure and in the other half, ice was applied directly before the removal. Pain was evaluated using a Visual Analog Scale and the differences were compared. Results: Statistically, there was a significant difference in pain control between EMLA cream group and ice application group (p<0.05). The average pain score among patients where EMLA cream was applied was 7.6 (SD = 0.81), whereas it was 5.1 (±0.9) in the ice group. Conclusion: In this study, use of ice application is helpful in reducing pain in comparison to EMLA cream during molluscum contagiosum needle extirpation. [ABSTRACT FROM AUTHOR]

Background: Rapid increase in demand for fast, effective and painless cosmetic procedures has inspired the pursue for the ideal method of anesthesia. The aim of the study was to compare the effectiveness of different types of topical anesthetics most commonly utilized in dermatological procedures: EMLA cream, BLT cream, infraorbital nerve blocks with 2% lidocaine with epinephrine. Material and Methods: The study involved 12 patients with scheduled painful dermatological procedures intended to improve their facial and neck skin. Pain intensity was measured using 0-10 numeric scale (10 being the worst imaginable pain and 0 no pain). Patients were asked to assess their pain levels during fractionated CO2 laser treatment of the face. Results: Results demonstrated that patients subjected to treatment with the use of anesthetic EMLA and BLT creams still feel a considerable level of pain during the performed dermocosmetic procedures. Similar pain level concerned the group anesthetized with the infraorbital nerve block injection. Conclusion: Finding the ideal topical anesthetic is one of the greatest challenges of present-day cosmetic dermatology. The most desired method of anesthesia in this context would have to be easy to apply, display high clinical effectiveness over a short time period, be able to exert numbing effect on intact skin without systemic effects, cause nominal pain or discomfort during treatment with minimal to no side effects. According to the results of the reported study, the most effective method of anesthesia was proved to be the triple anesthesia involving of a combination of a painkiller drug, EMLA cream and infraorbital nerve block. [ABSTRACT FROM AUTHOR]

EMLA cream was developed to reduce pain during pulsed-dye laser (PDL) treatment; however, no standard assessment for the therapeutic outcomes of PDL with EMLA creams thus far available. This comparative, prospective clinical trial evaluates laser efficacy and pain reduction during PDL treatment with EMLA cream for local topical anesthesia. Nineteen patients with untreated port-wine stain (PWS) were treated using PDL and examined in this study. Treatment specifications included Vbeam® PDL (Candela Corp.), 595-nm wavelength, 9 J/cm2 radiant exposure, 0.45 ms pulse duration, 10 mm spot size, and cryogen spray cooling (40 ms cooling plus a 20 ms delay). A topical anesthetic (EMLA cream: 2.5% lidocaine and 2.5% prilocaine) and a placebo were applied to two respective testing areas on all patients prior to treatment. The visual analog scale (VAS) was used for pain assessment. Clinical therapeutic outcomes were evaluated by visual evaluation and with the use of a chromameter 2 months after 3PDL treatments. The average VAS scores were 3.15 ± 0.95 and 8 ± 0.57 for the EMLA cream site and the placebo site, respectively, at a significance level p < 0.001. The EMLA cream site and the placebo site had clearance or fading rates of 45.08 and 44.12%, respectively (p < 0.05). No serious side effects were reported. Patients reported a consistent decrease in pain during PDL treatment when the topical anesthetic EMLA cream was administered. Treatment of PWS by PDL with EMLA cream does not lead to a decrease in efficacy or an increase in side effects; instead, it significantly reduces pain during treatment. EMLA cream is a safe and effective local topical anesthetic for PWS treatment by PDL. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to compare the effects of three interventions on pain, blood pressure, and pulse rate during infiltration anesthesia in patients about to undergo gamma knife surgeries. Methods: The three interventions employed in a university-affiliated Hospital in J City, South Korea were as follows: EMLA cream plus Vapocoolant spray (Vapocoolant, n=30), EMLA cream plus 10.0% Lidocaine spray (Lidocaine, n=30), and EMLA cream only (EMLA, n=30). The equivalent control-group pre test - post test study design was used. Pain was assessed subjectively using the numeric rating scale (NRS) and objectively using a Galvanic Skin Response (GSR) tester. NRS scores were assessed after infiltration anesthesia and the GSR was assessed during infiltration anesthesia. Blood pressure and pulse rate were assessed twice: before and after infiltration anesthesia. Data were collected between August 3, 2016 and March 24, 2017. Results: NRS scores after infiltration anesthesia and the GSR during infiltration anesthesia were significantly lower in the Vapocoolant group than in the Lidocaine and EMLA groups (F=13.56, p<.001 and F=14.43, p<.001, respectively). The increase in systolic blood pressure (F=4.77, p=.011) and in pulse rates (F=4.78, p=.011) before and after infiltration anesthesia were significantly smaller in the Vapocoolant group than in the Lidocaine and EMLA groups; however, no significant differences were observed in diastolic blood pressures (F=1.51, p=.227). Conclusion: EMLA cream plus Vapocoolant spray was the most effective intervention to relieve pain and to lower increase in systolic blood pressure and pulse rate caused by infiltration anesthesia for stereotactic frame fixation. Thus, application of Vapocoolant spray in addition to EMLA cream is highly recommended as a nursing intervention for patients undergoing gamma knife surgeries. [ABSTRACT FROM AUTHOR]

Background: Botulinum toxin is a safe and effective therapy for palmar hyperhidrosis, but the associated pain from injections limits the usefulness of this method of treatment. Purpose: To evaluate the efficacy of Eutectic Mixture of Local Anesthetics (EMLA) cream versus ice application in alleviation of pain during botulinum toxin injections for palmar hyperhidrosis. Methods: In this prospective study, 23 patients underwent palm Botox injections to treat their excessive sweating. In each patient, EMLA cream was applied to one palm and ice was applied directly before the injections in the other palm. Pain was evaluated using a Visual Analog Scale. Results: Statistically, there was a significant difference in pain control between EMLA cream group and ice application group (p<0.05). The average pain score on the hands where EMLA cream was applied was 8.9 (SD=0.81), whereas it was 4.8 (±0.9) in the ice group. Conclusion: In this study, the successful use of ice application in reducing pain by 40% in comparison to EMLA cream during Botox toxin injection for palmar hyperhidrosis is demonstrated. [ABSTRACT FROM AUTHOR]

Background. Congenital adrenal hyperplasia (CAH) is an endocrine condition that requires regularly blood samples for optimal treatment. The management of CAH in children is complex when intravenous access is one of the most stressful procedures for children. The purpose of this pilot study was to investigate the effects of nitrous oxide inhalation (N2O) in combination with cutaneous application of local anesthetics (EMLA) for improving intravenous access in children with CAH. Method. Ten children (7–14 years) were studied. The children received two intravenous procedures: one with EMLA and one with EMLA + N2O. The order of priority was randomized. The outcomes were the children’s pain experience (0–10) and an evaluation of satisfaction (1–5) after the procedure. Heart rate, blood pressure, saturation, and analyses of 17-hydroxyprogesterone (17-OHP), norepinephrine, and glucose were analyzed. Results. Higher pain scores, heart rate, and glucose levels were reported after EMLA, compared to EMLA + N2O, but 17-OHP levels remained unchanged. The children’s satisfaction with the intravenous procedure was more positive for EMLA + N2O. Conclusions. EMLA + N2O offers the possibility of improving the intravenous procedure for anxious children with CAH. Although the quality of care was better with N2O treatment, it was not possible to demonstrate that this is a prerequisite for valid 17-OHP measurements. [ABSTRACT FROM AUTHOR]

OBJECTIVES: There is no consensus on the most effective pain management for neonatal circumcision. We sought to compare different modalities. METHODS: This is a double-blinded randomized controlled trial comparing 3 combination analgesics used during circumcision (EMLA + sucrose; EMLA + sucrose + dorsal penile nerve block [DPNB]; EMLA + sucrose + ring block [RB]) with the traditional topical analgesic cream EMLA alone. The trial was set in the normal nursery of a teaching hospital. The sample included 70 healthy male newborns, randomly assigned to intervention and control groups at a 2:1 ratio. Infants were videotaped (face and torso) during the procedure for assessment of pain by 2 blinded, independent reviewers. The primary outcome measure is the Neonatal Infant Pain Scale score. Secondary outcomes include heart rate, oxygen saturation, and crying time. RESULTS: Neonatal Infant Pain Scale scores were significantly lower in the intervention groups (EMLA + sucrose, mean [SD]: 3.1 [1.33]; EMLA + sucrose + DPNB: 3 [1.33]; EMLA + sucrose + RB: 2.45 [1.27]) compared with the control (5.5 [0.53]). Between-group analyses showed RB + EMLA + sucrose to be significantly more effective than EMLA + sucrose; EMLA + sucrose + DPNB (P = .009 and P = .002, respectively). Interrater reliability was κ = 0.843. Significant increase in heart rate (139.27 [9.63] to 163 [13.23] beats per minute) and crying time (5.78 [6.4] to 45.37 [12.39] seconds) were noted in the EMLA group. CONCLUSIONS: During neonatal circumcision in boys, the most effective analgesia is RB combined with oral sucrose and EMLA cream. [ABSTRACT FROM AUTHOR]

Purpose: Aim of the study was to investigate the topical application of a eutectic mixture of lidocaine/prilocaine (EMLA®) cream after caesarean section (CS) and its effect on postoperative pain, time to mobilisation, and time to discharge.Materials and Methods: A total of 189 pregnant women were enrolled; full data sets were available for 139 of them, who were prospectively randomised to receive either placebo (control group) or EMLA® cream (study group) on the CS lesion directly as well as 24 h after surgery. Postoperative pain was assessed 24 and 48 h after surgery using the short form of the McGill Pain Questionnaire (SF-MPQ). Additional analgesic pain medication on demand was assessed in both groups.Results: A total of 62 women were allocated randomly to the study and 77 patients to the control group before primary CS. There were no statistically significant differences regarding demographic and surgical parameters comparing both collectives. In addition, the postoperative total pain scores after 24 h [McGill total: 38.5 (0-102) vs. 50 (0-120) p = 0.0889] as well as after 48 h [24 (0-79) vs. 30.5 (0-92); p = 0.1455] showed no significant differences. Furthermore, time to mobilisation (hours) [9.68 (2.18-51.38) vs. 9.47 (4.18-41.77); p = 0.5919] and time to discharge (hours) [98.6 (54.08-170.15) vs. 98.2 (43.45-195.87); p = 0.5331] were comparable.Conclusion: The postoperative application of EMLA® cream after CS did not reduce postoperative pain or time to mobilisation or discharge, so that its use in this context has to be seen critically. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to identify interventions associated with peripheral intravenous catheterization first attempt success in pediatric inpatients and emergency department patients who require vascular access for therapeutic interventions. Background Unsuccessful peripheral intravenous catheterization puts children at risk for increased pain and treatment delays. Effective interventions to increase peripheral intravenous catheterization first attempt success are unclear. Design Systematic review of randomized controlled trials according to the Cochrane Handbook for the Systematic Review of Interventions. Data sources Through November and December 2014, we searched 10 databases including MEDLINE ( OVID), EMBASE ( OVID) and CINAHL ( EBSCO) without date limits. The references of articles were also reviewed. We included full text reports of randomized controlled trials testing intervention first attempt success rates vs. standard of care. Review methods According to inclusion and exclusion criteria set a priori, data were extracted using a standardized tool. We assessed for risk of bias with the Cochrane Collaboration Risk of Bias Tool. Due to unclear reporting narrative synthesis was used to report results. Results Four cluster randomized control trials and ten randomized control trials involving 4539 participants ranging from 15·6 days to 16 years of age met our inclusion criteria. We excluded the four cluster trials from meta-analysis due to unclear reporting. Interventions did not increase first attempt success rate compared with standard of care. Conclusions There was insufficient evidence to support the use of ultrasound, infrared light or transillumination. Interventions to reduce children's pain did not decrease first attempt success. Research examining between-clinician proficiency and persistence differences is absent. [ABSTRACT FROM AUTHOR]

Benznidazole (BNZ), the only commercialized antichagasic drug, and the antifungal compound posaconazole (PCZ) have shown synergistic action in the therapy of Chagas disease, however both active pharmaceutical ingredients (APIs) exhibit low aqueous solubility potentially limiting their bioavailability and therapeutic efficacy. In this paper, we report for the first time the formation of a eutectic mixture as well as an amorphous solid solution of PCZ and BNZ (at the same characteristic ratio of 80:20 wt%), which provided enhanced solubility and dissolution rate for both APIs. This eutectic system was characterized by DSC and the melting points obtained were used for the construction of a phase diagram. The preservation of the characteristic PXRD patterns and the IR spectra of the parent APIs, and the visualization of a characteristic eutectic lamellar crystalline microstructure using Confocal Raman Microscopy confirm this system as a true eutectic mixture. The PXRD result also confirms the amorphous nature of the prepared solid solution. Theoretical chemical analyses indicate the predominance of π-stacking interactions in the amorphous solid solution, whereas an electrostatic interaction between the APIs is responsible for maintaining the alternating lamellar crystalline microstructure in the eutectic mixture. Both the eutectic mixture and the amorphous solid solution happen to have a characteristic PCZ to BNZ ratio similar to that of their pharmacological doses for treating Chagas disease, thus providing a unique therapeutic combination dose with enhanced apparent solubility and dissolution rate. [ABSTRACT FROM AUTHOR]

Degradation of an Inconel 601 superalloy subjected to a eutectic mixture of carbonate salt at 450 °C was studied using advanced microscopy and microanalysis techniques. On the outside of the vessel, long term exposure to elevated temperature led to intergranular stress corrosion cracking via a stress assisted oxidation process. Elemental analysis verified diffusion controlled de-alloying of Ni and Cr from grain boundaries. Transmission electron microscopy showed that a (CrFeNiAl) 3 O 4 oxide phase was formed at grain boundaries as a result of oxygen penetration. Intergranular cracking appeared due to the presence of residual stresses and microstructural heterogeneities facilitated the crack branching. [ABSTRACT FROM AUTHOR]

Dental pain management is one of the most critical aspects of modern dentistry which might affect patient's quality of life. Several methods are suggested to provide a painless situation for patients. Desensitization of the oral site using topical anesthetics is one of those methods. The improvements of topical anesthetic agents are probably one of the most important advances in dental science in the past 100 years. Most of them are safe and can be applied on oral mucosa with minimal irritation and allergic reactions. At present, these agents are various with different potent and indications. Eutectic mixture of local anesthetics (EMLA) (lidocaine + prilocaine) is a commercial anesthetic agent which has got acceptance among dental clinicians. This article provides a brief review about the efficacy of EMLA as a topical anesthetic agent when used during dental procedures. [ABSTRACT FROM AUTHOR]

Despite the potentials of deep eutectic solvent (DES) for application in variety of fields, the perfect DES with the exact desired properties is hard to come by. This is due to lack of understanding of their exact nature, which would allow for appropriate choice of the DES constituents to obtain the desired properties. One way DES properties can be fine-tuned to a specific application is via mixing with another DES. This does not only allow for the formation of task specific solvent but also presents us with the opportunity of studying intermolecular forces of attraction via a macroscopic thermodynamic property (excess molar volume). In this work, the DES mixture Reline-Ethaline was synthesized at different molar fractions of Ethaline. The excess molar volume of this system was evaluated, and its effect on the physical properties of DES mixture was discussed. The physical properties measured were molar volume, viscosity, conductivity, refractive index and pH at different molar fractions of Ethaline (0.1, 0.3, 0.5, 0.7, and 0.9), and temperatures (20-80 °C). © 2016 Curtin University of Technology and John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Caudal block is a popular regional anesthesia in children undergoing infraumbilical surgeries including inguinal hernia repair and orchiopexy. We evaluated the efficacy of eutectic mixture of local anesthetic (EMLA) cream for reducing needle insertion pain during caudal block in pediatric patients. Methods: Forty-one children between the ages of 13 months and 5 years undergoing infraumbilical surgery were randomized to receive either topical EMLA or placebo cream over the sacral hiatus one hour before caudal block. All children were assessed with the Multidimensional Assessment Pain Scale (MAPS) at the following time points. T0: arrival at the operation room; T1: just before needle insertion; T2: immediately after needle insertion into the sacral hiatus. The need for sevoflurane inhalation due to procedural pain response was also assessed at the same time as MAPS assessment. Results: MAPS scores were significantly lower in the EMLA group compared with the placebo group at T2 (P = 0.001). Moreover, need for sevoflurane inhalation due to procedural pain response was significantly lower in the EMLA group compared with the control group at T2 (P < 0.001). Conclusions: We suggest that pretreatment with EMLA cream over the sacral hiatus before caudal block has significant advantages in alleviating procedure pain during caudal block in children. [ABSTRACT FROM AUTHOR]

The authors compared the analgesic effects of two topical applications; Emla®cream (Sato Pharmaceutical Co. Ltd., Tokyo, Japan) and 60% lidocaine tape (Penles®tape; Maruho, Osaka, Japan). The authors examined 20 outpatients with capillary malformations. Emla®cream or Penles®tape was applied 1 h before laser irradiation using V-Beam. After V-Beam irradiation, pain intensity was measured using Pain Vision®(NIPRO, Osaka, Japan), while subjective pain was converted into numerical values using the VAS system. In the assessment using Pain Vision®, pain was significantly lower in patients who received Emla®cream (Welch test), whereas no difference was observed in VAS ratings between the two applications (student’sttest). The objective system showed that Emla®cream had a significantly greater analgesic effect. We plan to evaluate the analgesic effects of these topical anesthetics by applying them to other anatomical areas. [ABSTRACT FROM AUTHOR]

Local anesthesia in the skin occurs approximately 1 h after application of a commercial topical formulation of lidocaine and prilocaine prepared as a eutectic mixture. A number of lidocaine salts was screened and lidocaine-ibuprofen was found to form a room-temperature ionic liquid. When applied to the skin of rats, local anesthesia of skin was achieved within 10-20 min in the rats' paws and tails with no apparent adverse effects to the skin as determined by histological analysis. We believe that the lidocaine-ibuprofen ionic liquid increased lidocaine absorption into the skin due to the high lidocaine concentration in the ionic liquid and due to possible interactions between the ionic liquid and the skin to increase skin permeability. These findings suggest that lidocaine-ibuprofen ionic liquid may provide a more rapid method of drug delivery to the skin for local anesthesia. © 2015 American Institute of Chemical Engineers AIChE J, 61: 2732-2738, 2015 [ABSTRACT FROM AUTHOR]

Background: Premature infants, who have to spend the first week of their lives in neonatal intensive care units (NICUs), experience pain and stress in numerous cases, and they are exposed to many invasive interventions. The studies have shown that uncontrolled pain experienced during early life has negative and long-term side effects, such as distress, and such experiences negatively affect the development of the central nervous system Objectives: The purpose of the study was to examine the effects of touching on infant pain perception and the effects of eutectic mixture of local anesthetic (EMLA) on the reduction of pain. Patients and Methods: Data for the study were collected between March and August 2012 from the neonatal clinic of a university hospital located in eastern Turkey. The population of the study consisted of premature infants who were undergoing treatment, completed the first month and who were approved for Hepatitis B vaccine. The study consisted of two experimental groups and one control group. Information forms, intervention follow-up forms, and Premature Infant Pain Profile (PIPP) were used to collect the data. EMLA cream was applied on the vastus lateralis muscles of the first experimental group before the vaccination. The second experimental group was vaccinated by imitation (placebo), without a needle tip or medicine. Vaccination was carried out using instrumental touch in this group. A routine vaccination was applied in the control group. Results: Mean pain scores of the group to which EMLA was applied were lower in a statistically significant way (P < 0.05) compared to the pain scores of the other groups. Moreover, it was determined that even though invasive intervention was not applied to the newborns, the touching caused them to feel pain just as in the placebo group (P < 0.005). Conclusions: The results demonstrated that EMLA was an effective method for reducing pain in premature newborns, and the use of instrumental touch for invasive intervention stimulated the pain perception in the newborns. [ABSTRACT FROM AUTHOR]

Purpose: Aim of this prospective study was to investigate the effectiveness of eutectic mixture of local anaesthetic (EMLA) patches on every abdominal incision for pain relief after gynaecologic laparoscopic surgery. Methods: A total of 121 women were prospectively randomised to receive either placebo (control group) or EMLA (study group) patches on all abdominal incisions. Postoperative pain was assessed 24 and 48 h after surgery using the short form of the McGill Pain Questionnaire (SF-MPQ). The amount of analgesic pain medication on demand was assessed in both groups. Results: Sixty women were allocated to the study group and 61 patients to the control group before laparoscopic surgery. There were no statistically significant differences regarding age, body mass index (BMI), duration of surgery and blood loss comparing both groups. There were no statistically significant differences between both groups with regard to postoperative total pain scores 24 h (McGill total score: 31.77 ± 27.95 vs. 36.80 ± 31.39, p = 0.3535) and 48 h (McGill total score: 19.18 ± 20.09 vs. 26.61 ± 27.70, p = 0.0942) after surgery. Time to mobilisation after surgery (hours) was significantly shorter in the study group (5.01 ± 3.72 vs. 5.78 ± 3.04, p = 0.0423). Conclusion: Despite of a significant reduction of time for mobilisation transdermal anaesthetic patches after gynaecologic laparoscopic surgery did not lead to decreased postoperative pain scores. [ABSTRACT FROM AUTHOR]

Background Topical anesthetics, such as eutectic mixture of local anesthetics (EMLA) cream, can be applied to reduce pain before minor procedure. This trial evaluated EMLA as pretreatment for facial lacerations and compared pain, discomfort and overall satisfaction. Methods This trial included consecutive emergency department patients ≥16 years of age who presented with simple facial lacerations. At triage, lacerations were allotted to either the routine processing group or EMLA pretreatment group according to date of admission. Initially, the emergency department doctors inspected each laceration, which were dressed with saline-soaked gauze. In the pretreatment group, EMLA cream was applied during wound inspection. The plastic surgeon then completed primary closure following the local injection of an anesthetic. After the procedure, all patients were given a questionnaire assessing pain using the 10-point visual analog scale (VAS) ("no pain" to "worst pain"). All questionnaires were collected by the emergency department nurse before discharge. Results Fifty patients were included in the routine processing group, and fifty patients were included in the EMLA pretreatment group. Median age was 39.9 years, 66% were male, and the average laceration was 2.67 cm in length. The EMLA pretreatment group reported lower pain scores in comparison with the routine processing group (2.4 vs. 4.5 on VAS, P<0.05), and lower discomfort scores during the procedure (2.0 vs. 3.3, P=0.60). Overall satisfaction was significantly higher in the EMLA pretreatment group (7.8 vs. 6.1, P<0.05). Conclusions Pretreating facial lacerations with EMLA topical cream aids patients by reducing pain and further enhancing overall satisfaction during laceration treatment. [ABSTRACT FROM AUTHOR]

Background: Hysterosalpingography (HSG) is considered as a primary test in infertility work up worldwide due to its reliability in evaluating abnormalities related to the uterus and fallopian tubes. Objectives: To assess the efficacy of applying eutectic mixture of local anesthetics (lidocaine-prilocaine cream) (EMLA) on the uterine cervix in reducing pain during HSG. Patients and Methods: Eighty patients undergoing HSG as part of infertility evaluation were randomly allocated to groups receiving either EMLA (N = 40) or placebo cream (N = 40) in a double-blinded prospective study. Fifteen minutes before HSG, 5 grams of 5% cream was applied to the uterine cervix using a cervical applicator. The degree of pain experienced by the patient was evaluated during and after HSG at five predefined steps on a visual analogue scale (VAS). Results: There was no significant difference in the efficacy between EMLA and placebo creams in pain perception during the entire procedure. There was no significant difference in long term pain perception halfan hour after the HSG performance. Conclusions: This study does not support the use of EMLA for HSG. [ABSTRACT FROM AUTHOR]

Objective To investigate a topical local anesthesia technique as a means to prevent and/or diminish pain in mice in a laboratory setting associated with tail vein injections performed by personnel in training. Study design Prospective, randomized experimental trial. Animals Thirty six adult female, 23-28 g CD-1 mice from an in-house training colony. They were acclimated to routine training and handling classes. Methods Eutectic mixture of local anesthetics ( EMLA) cream (2.5% lidocaine/2.5% prilocaine) or a bland ointment control ( n = 18) was applied on the tail prior to intravenous injection. The injections were performed by novices, who had never attempted the procedure, and experienced personnel. All participants were blinded to treatment groups. Three injection attempts were allowed per animal. The mice were observed and scored by blinded evaluators for behavioral and physiological changes, including respiratory rate, vocalization, tail flick, and escape behaviors, during and after the injection. Results This study demonstrates that aversive behaviors induced by lateral tail vein injection were not changed by the preemptive application of EMLA cream. The aversive behaviors associated with lateral tail vein injection were significantly affected by the number of injection attempts and the individual's experience level. Conclusions and clinical relevance Topical EMLA cream did not reduce signs of aversive reaction to tail vein injection and thus we did not find support for its use in mouse training programs for tail vein injections. [ABSTRACT FROM AUTHOR]

Radiofrequency volumetric tissue reduction is a minimally invasive technique in the treatment of turbinate hypertrophy and is generally performed under local anesthesia. However, perioperative discomfort and pain are common side effects and studies concerning the technique of choice to anesthetize the nasal mucosa in this procedure are lacking. The aim of this prospective controlled trial is to assess the effectiveness of EMLA cream as a topical anesthetic for radiofrequency volumetric tissue reduction of inferior turbinates comparing its effect with that obtained using a traditional anesthetic technique. 200 consecutive patients undergoing volumetric tissue reduction with topical anesthesia were enrolled. Patients were divided into two groups: Group A included 100 patients treated by placing cotton pledgets soaked with lidocaine 10 % in the inferior meatus followed by the injection of 2 % lidocaine into the head of the inferior turbinate; Group B included 100 patients treated with EMLA cream. Patients were evaluated before and after surgery using rhinomanometry for obstructive symptoms. Four VAS about pain, troublesome swallowing, choking sensation and intraoperative anxiety were submitted to each patient immediately after surgery and after 2 months to assess various aspects of perioperative discomfort. A significant increase of nasal airflow was observed without differences between the two groups. Subjective evaluation regarding perioperative discomfort showed significant differences between Groups A and B immediately after surgery although it was less pronounced 2 months later. The results of this study suggest that EMLA cream is an efficient tool in obtaining an adequate anesthetic effect in this procedure. [ABSTRACT FROM AUTHOR]

The present work investigates the mechanical behaviour of an aspirin-paracetamol (ASP-PCM) eutectic mixture (EM). A EM of ASP-PCM was prepared using a solvent evaporation method. Differential scanning calorimetry (DSC) and powder X-ray diffraction (PXRD) confirmed the eutectic formation with a composition of 53 : 47% w/w (ASP :PCM). The compaction behaviour of the EM and a physical mixture (PM) of ASP and PCM was compared using a fully instrumented rotary tablet press equipped with a Portable Press Analyzer™ (PPA). The obtained data were compared using compressibility, tabletability and compactibility profiles and Heckel analysis. The EM exhibited higher compressibility, tabletability and plastic deformation compared to the PM. Heckel analysis showed that the mean yield pressure, Py, was lower for the EM (46.9 MPa) than the PM (222.8 MPa), thus confirming the better plastic deformation of the EM. The better deformation behaviour of the EM was attributed to its layered microstructure. The sliding of adjacent layers over each other under an applied compaction pressure offered higher plastic deformation and thus provided a greater interparticulate bonding area in the EM compared to the PM. However, there was no significant difference in the compactibility profiles indicating a similar interparticulate bonding strength of the two powders. Thus, the EM showed better tabletability compared to the PM by virtue of its greater compressibility and plastic deformation. [ABSTRACT FROM AUTHOR]

Providing sedation for patients with compromised upper airway is challenging. A 19-year-old female patient with huge maxillofacial tumor invading the whole pharynx scheduled for elective tracheostomy under local anesthesia due to compromised airway. The patient had gastrostomy tube for feeding. Venous cannulation was totally refused by the patient after repeated trials for exhausted sclerosed veins. Pre-operative mixture of dexmedetomidine with ketamine was administered through the gastrostomy tube with eutectic mixture of local anesthetics cream application over the planned tracheostomy site. The patient was sedated with eye opening to command. Local infiltration followed by tracheostomy was performed without patient complaints or recall of operative events. [ABSTRACT FROM AUTHOR]

In the study we observed the effects of placebo and "anti-placebo" messages on the neural activities registered through the event related potentials (ERP). Instead of commonly used term nocebo, we used the term "anti-placebo", given that the message we delivered was not supposed to induce the negative effects, but just to diminish the effect of placebo. Thermal stimulus of 45 degrees of Celsius was applied on the skin of 29 students in a four different experimental situations: without analgesia, after receiving dermal analgesic EMLA Cream, after receiving neutral skin cream presented as an analgesic (placebo situation), and after receiving again EMLA Cream, but presented as the herbal analgesic not officially accepted as a medicament ("anti-placebo" situation). Immediately after stimulation, participants were asked to estimate the level of "unpleasantness" of the stimuli on the subjective scale ranging from 1-10, and to start a cognitive experiment, during which the ERP responses were measured. Results showed three main ERP effects. In the early effect, we noticed that all three experimental situations with analgesia (that is, two conditions with the pharmaco-analgesia + the condition with the placebo analgesia) showed a different ERP effects in comparison to the condition with no analgesia. We interpreted these results as early expectancies that any analgesic (including placebo) should produce some effect in comparison to no-analgesic condition. In the medium effect, we observed significantly longer durations of the ERP effects in the situation of the "anti-placebo" and no-analgesia, whereas in the analgesia and placebo condition these effects were much shorter. This result led us to the conclusion, that on the neural level, our suggestion of "bad medicament" (similar to situation of no-medicament) caused a specific mental activity registered on ERP. This effect is the one which calls into a question doctors' ecommendations (which contain negative connotation) of medicaments, as they could potentially and unconsciously diminish a valuable impact hat the placebo could have during a treatment. Finally, in the late effect, we also observed significant differences across the four experimental conditions, but these differences were directly correspondent with the order of presentation of experimental situations, and we interpret them as an artefact of the experimental design. [ABSTRACT FROM AUTHOR]

The primary objective was to evaluate the analgesic effect of a eutectic mixture of local anesthetics (EMLA) during whole cell DPT vaccination. The secondary objective was to evaluate if the analgesic effect of EMLA was synergistic to breastfeeding. A randomized, placebo-controlled trial was done to include infants of up to 3 months of age who came for their first DPT vaccination. The outcome variables were duration of cry, latency of onset of cry, and Modified Facial Coding Score. Thirty babies were enrolled in each of three groups. The groups did not differ significantly in baseline characteristics. Median (interquartile range) of duration of cry was least [34.6 (24.1-72.2) s] in babies receiving EMLA cream with breastfeeding (EB group), followed by 94.2 (46.1-180) s in babies receiving EMLA cream with oral distilled water (EW group), as compared to 180.0 (180-180) s in babies receiving placebo cream with oral distilled water (PCW group) ( p < 0.05). Mean (SD) of latency of cry was significantly greater in EB group [2.4 (1.14) s] and EW group [1.9 (0.62) s] as compared to babies in PCW group [1.5 (0.47) s] ( p < 0.05), but the difference between EB and EW groups was not significant. Modified Facial Coding Score was significantly lower in EB group as compared to the other groups ( p < 0.05). Conclusions: Topical EMLA is effective in reducing pain and has a synergistic effect in analgesia when combined with breastfeeding during vaccination in infants. [ABSTRACT FROM AUTHOR]

Introduction: The venipuncture is the method of choice for blood sampling in the neonate, causing moderate pain intensity. The use of glucose and the aplications of EMLA cream are the most studied interventions of pain in neonates, with varying results. Objectives: Evaluate the analgesic effect of 25% dextrose solution and EMLA cream in premature neonate measured by the PIPP pain scale during the venipuncture for blood sampling and during his internment in the Neonatology Service of the Children's Hospital of Sonora (HIES). Methods: A controlled, double-blind, randomized,clinical study was performed, in the service of growth and development at our Children's Hospital, in 24 prematures of 28 to 36.6 weeks of gestation. They were divided into 2 groups: group 1 was given 0.5 ml of 25 dextrose solution by suction and in group 2 EMLA cream was applied prior to blood sampling by venipuncture. They were assessed with the Scale of Pain Profile of the Premature (PIPP). Results: There was no significative difference in the pain scale score between infants who received 25% of dextrose solution and those who received EMLA cream at p 0.1046. Conclusion: Both use of 25% dextrose solution as the aplication of EMLA cream were equally effective in reducing pain during venipuncture. We recommend using 25% of dextrose solution that is non-invasive, with easy acquisition and for their safety. [ABSTRACT FROM AUTHOR]

EMLA® (eutectic mixture of local anesthetics, 2.5% each of lidocaine and prilocaine in an oil and water emulsion) is used as a topical anesthetic. We report three cases of EMLA®-induced histopathologic changes on the vulvar epithelium. While there are some similar histopathologic features to those reported in extragenital skin, we describe additional findings on vulvar epithelium, which, to our knowledge, have not been reported previously. The patients presented with clinical signs suggestive of lichen sclerosus or erosive lichen planus (LP), but were all confirmed histopathologically as LP. The biopsy was taken after 15 min of EMLA® application and intradermal injection of 1% lidocaine. Blistering prior to intradermal lidocaine and the biopsy procedure was observed in two patients. The histopathologic changes observed in the epithelium included pallor of the upper epidermis, mild spongiosis, intraepidermal subcorneal and suprabasal acantholysis, congestion of the papillary dermal capillaries and extravasated erythrocytes. Basophilic granules were present, but rare, while the necrosis with multifocal clefting was more marked than in extragenital skin. It is important to be aware of these changes occurring on genital mucosa; these may occur in the absence of clinical signs and may obscure the primary underlying pathology, thus representing a diagnostic pitfall. [ABSTRACT FROM AUTHOR]

Purpose: Intravenous cannulation is a painful and stressful procedure. The objective of this study was to compare the analgesic efficacy of the eutectic mixture of local anesthetics (EMLA) with that of the Valsalva maneuver in adult patients during i.v. cannulation. Methods: One hundred ninety-five patients were randomized prospectively to three groups. The dorsum of the nondominant hand was covered with a thick paste of 2.5 g of EMLA cream in the EMLA group (group E) and left for a minimum of 30 min before venipuncture. In the control group (group C), the same procedure was applied except that Vaseline was used instead of the EMLA. The Valsalva group (group V) were punctured during a Valsalva maneuver. The patients were placed in the supine position during venipuncture. The patients then scored the amount of pain on cannulation using an 11-point numerical rating scale (NRS; 0 = no pain, 10 = extreme pain). Results: Thirteen patients were excluded from the analysis due to failed cannulation. There was no difference in the demographic profiles of the groups ( p > 0.05). The success of VP was significantly higher in group V than in groups E and C ( p < 0.001). The median pain score as assessed by the NRS after venipuncture in group C was 3 (range 0-9), whereas the median pain values in groups E and V were 2 (range 0-7) and 2 (range 1-8). Conclusions: The Valsalva maneuver yields similar results to the EMLA in terms of pain reduction during venipuncture. [ABSTRACT FROM AUTHOR]

Venipuncture and intravenous cannulation are the most common painful procedures performed on children. The most widely used topical anesthetic is eutectic mixture of local anesthetics (EMLA). EMLA use is associated with a transient cutaneous vasoconstriction which can make it difficult to identify veins. We assessed with a prospective, multicenter, observational study whether EMLA interferes with venipuncture and intravenous cannulation. The primary study outcome was a success at first attempt in the course of venipuncture or venous cannulation. The study enrolled 388 children; 255 of them received EMLA and 133 did not. Eighty-six percent of procedures were successful at the first attempt in the EMLA group and 76.7 % in the no EMLA group. Conclusion: In this study, EMLA use did not interfere with the success of venipuncture or venous cannulation in children. [ABSTRACT FROM AUTHOR]

Objective: Circumcision is a commonly performed surgical procedure but choice of anesthesia remained an issue of research and debate. This study was conducted to find out the effectiveness of the eutectic mixture of local anesthetic (EMLA) cream with dorsal penile nerve block (DPNB) using lignocaine, for reduction of pain during circumcision. Methodology: This was comparative study carried out in Surgical Unit B of National Institute of Child Health Karachi, from May 2008 to October 2008. Patients under six month of age were randomized in to two groups (EMLA and DPNB) of fifty patients each. The effectiveness of pain control was assessed by measuring the baseline heart rate (HR), respiratory rate (RR) and Neonatal infant Pain Scale (NIPS scale) before the start of procedure and measuring of these parameters for each step of circumcision. Independent sample t -test was used to compare means and repeated ANOVA was used to compare means of HR, RR, oxygen (O2) saturations and NIPS. Results: The mean age in both the groups was 2.3 months. There was no statistically significant difference in baseline parameters in both the groups except the respiratory rate, which was significantly raised in DPNB group (33 breaths/min in EMLA and 38 in DPNB P < 0.04). During circumcision there was significant increase in heart rate in DPNB group, especially in step three and step four (p < 0.04). Oxygen saturation dropped in both the groups (baseline saturation 98% up to 91% in step 4). While assessing NIPS scores in both the groups, statistically significant difference was found between NIPS at step two and step four in two groups (p < 0.04). Conclusions: The overall pain control was equal in both the groups, although NIPS score was higher in DPNB in step two and four of circumcision. There was difference in application and cost. EMLA was easy to apply but has increased cost; while DPNB required expertise. [ABSTRACT FROM AUTHOR]

The article presents a study that investigates the efficacy of the Eutectic Mixture of Local Anesthetics (EMLA) in boosting success of venipuncture practice of the emergency department (ED) of hospitals in the U.S. Researchers did the study on 37 weeks gestational age children to 18 years-old individuals who need venipuncture to reduce the pain associated with triage. They found that venipuncture is effective in reducing the pain experienced by patients.

Male circumcision (MC) is one of the oldest and most common operations performed all over the world. It can be performed at different ages, using different surgical techniques, for different religious, cultural and medical reasons. Our aim is to examine and compare the various methods of analgesia and different surgical procedures reported in literature that are applied in infant MC. We performed a PubMed, MEDLINE, EMBASE and Cochrane search in the papers published since 2000: 14 studies met the inclusion criteria, most of them showing that a combined pharmacological and non-pharmacological intervention is the best analgesic option, in particular when the dorsal penile nerve block is combined with other treatments. The Mogen surgical procedure seems to be the less painful surgical intervention, when compared with Gomco clamp or PlastiBell device. Only 3 papers studied groups of at least 20 babies each with the use of validated pain scales. Data show a dramatic decrease of pain with dorsal penile nerve block, plus acetaminophen associated to oral sucrose or topic analgesic cream. However, no procedure has been found to definetively eliminate pain; the gold standard procedure to make MC totally painfree has not yet been established. [ABSTRACT FROM AUTHOR]

The main goal of the present retrospective study is to compare four analgesic methodologies (EMLA cream, propofol, thiopental sodium, sevoflurane) for in vitro fertilization (IVF) oocyte retrieval. We found that most anaesthetic parameters were not significantly different among all treatments. In contrast, significant differences were revealed in all groups for total number of oocytes retrieved per patient, rate of mature oocytes at metaphase II stage (MII) and percentage of fertilization and embryo development. In the EMLA cream and thiopental sodium groups we observed the highest percentage of MII oocytes ( P < 0.001). Fertilization rate in the EMLA and sevoflurane groups were similar but significantly higher than the propofol and thiopental sodium groups ( P < 0.001). The highest rate of anomalous fertilization was observed in the propofol group. Rate of embryo development was similar in all groups but sevoflurane group had a lower percentage of good embryos. In conclusion, by comparing different anaesthetic techniques with different mechanisms of action and administration, potential negative effects of these drugs on the initial stages of human IVF procedure were revealed. Therefore, a local anaesthetic cream is proposed as an acceptable alternative option for anaesthesia during transvaginal oocyte retrieval. [ABSTRACT FROM AUTHOR]

Background and Objectives: A variety of surgical procedures of the penis can be performed under local anesthesia. We evaluated the efficacy and safety of EMLA cream anesthetic in such procedures. Materials and Methods: In total 330 adult patients were subjected to minor penile surgery including: Complete circumcision (73), short frenulum plasty (168), meatotomy (14), fulguration of penile warts (56) and fulguration of urethral (meatal) warts (19). The level of anesthesia obtained by EMLA cream application along with any adverse effects was recorded. Results: The use of EMLA on mucosal lesions provided excellent level of local anesthesia in almost all patients (245/246, 99.5%). Anesthesia of skin lesions was in part influenced by the site of application. Circumcision patients showed the lowest efficacy of the EMLA cream as the majority (∼80%) required some form of further anesthesia until the completion of the procedure. No significant adverse effects were noted. A transient erythema was present in almost all mucosal applications. Conclusions: The topical anesthetic EMLA cream is a useful, efficient and safe tool for minor surgical procedures of the penis at the office setting, with the exception of circumcision, where an additional type of anesthesia is likely to be necessary. Side effects can be kept to a minimum when the suggested doses are respected (especially at mucosal application) and the time allowed for action is carefully tailored to the site of application and the type of procedure. [ABSTRACT FROM AUTHOR]