Volume: 11 Issue: 1
Year: 2023, Page: 25-29, Doi: https://doi.org/10.47799/pimr.1101.04
Received: Jan. 10, 2023 Accepted: March 2, 2023 Published: March 2, 2023
Introduction: Needle prick pain is a distressing event for a patient receiving spinal anaesthesia. A ‘Needle piercing the spine’ might be physically and mentally traumatizing for many patients. This may lead to unwanted panic and anxiety during the procedure of spinal anaesthesia. To avoid this distressing needle prick pain, many clinicians have resorted to the practice of giving injections of local anaesthetic or local application of EMLA cream or patch at the site of spinal puncture beforehand for anaesthetizing the skin and subcutaneous tissues.
Methods: A prospective cohort study was done. Those enrolled patients were assessed by an expert anesthesiologist, who was not part of the research team, and he prescribed patients either EMLA cream or regular standard lignocaine infiltration anaesthesia and labelled them as Group E and Group L respectively. The pain score was assessed using a Visual Analogue Scale.
Result: A total of 64 patients were enrolled in the study- 33 in Group E and 31 in Group L. Both groups had an almost similar number of patients who had a similar extent of surgery. Univariate analysis showed that the mean pain score (VAS) was significantly higher in Group E patients compared to that in Group L, p<0.001. The multivariate analysis had similar findings after controlling confounding factors in multiple regression analysis.
Conclusion: Local 2% lignocaine injection achieved significantly more pain reduction during spinal needle insertion compared to the application of an EMLA patch before spinal anaesthesia.
Keywords: EMLA, Lignocaine, VAS, Visual Analogue Scale, Needle insertion, Spinal Anaesthesia
Whiteside, J B & Wildsmith, JAW . 2005. Spinal anaesthesia: an update. Continuing Education in Anaesthesia Critical Care & Pain 5(3):37–40.
Luck, J F, Fettes, PDW & Wildsmith, JAW . 2008. Spinal anaesthesia for elective surgery: a comparison of hyperbaric solutions of racemic bupivacaine, levobupivacaine, and ropivacaine. Br J Anaesth 101(5):705 –710.
Chapter 45. In: Morgan & Mikhail’s Clinical Anesthesiology (7). (pp. 960-970) AccessMedicine | McGraw Hill Medical
Oliver, J & Zeballos, J L . 2015. Spinal Anesthesia. In: Aglio, Linda S, W, Robert & D, Richard , eds. Essential Clinical Anesthesia Review: Keywords, Questions and Answers for the Boards. (pp. 187-196) Cambridge University Press
Rathmell, JP, Flood, P & Shafer, S . 2015. Stoelting's Pharmacology and Physiology in Anesthetic Practice. (pp. 5) Wolters Kluwer Health
Bjerring, P & Arendt-Nielsen, L . 1990. Depth and duration of skin analgesia to needle insertion after topical application of EMLA cream. Br J Anaesth 64(2):173–180.
Hallén, B, Olsson, G L & Uppfeldt, A . 1984. Pain-free venipuncture: Effect of timing of application of local anaesthetic cream. Anaesthesia 39(10):969–972.
Ohlsén, L, Englesson, S & Evers, H . 1985. An anaesthetic lidocaine/prilocaine cream (EMLA) for epicutaneous application tested for cutting split skin grafts. Scand J Plast Reconstr Surg 19:201–210.
Babamohamadi, H, Ameri, Z, Asadi, I & Asgari, M R . 2022. Babamohamadi H, Ameri Z, Asadi I, Asgari MR: Comparison of the Effect of EMLATM Cream and the Valsalva Maneuver on Pain Severity during Vascular Needle Insertion in Hemodialysis Patients: A Controlled, Randomized, Clinical Trial. Evid Based Complement Alternat Med 2022(83021).
Leung, YL . 2014. Lidocain. In: Encyclopedia of Toxicology. (pp. 71-74)
Myles, P S, Myles, D B, Galagher, W, Boyd, D, Chew, C, Macdonald, N & Dennis, A . 2017. Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and patient acceptable symptom state. BJA: British Journal of Anaesthesia 118(3):424–433.
Sharma, S K, Gajraj, N M, Sidawi, E J & Lowe, K . 1996. EMLA cream effectively reduces the pain of spinal needle insertion. Regional Anesthesia: The Journal of Neural Blockade in Obstetrics 21(6):561–565.
Koscielniak-Nielsen, Z, Hesselbjerg, L, Brushøj, J, Jensen, Britt, M, Pedersen, Stens & H . 1998. EMLA patch for spinal puncture: A comparison of EMLA patch with lignocaine infiltration and placebo patch. Anaesthesia 53(12):1218–1240.
Doi, K, Ueda, Y & Imamachi, N . Use of EMLA cream for skin anaesthesia and epidural insertion in the patients with cesarean delivery: A prospective double-blind randomized clinical trial. Saudi J Anaesth 2022:145.
Baek, I C, Choi, S Y, Suh, J & Kim, S H . 2019. The influence of local anaesthesia depth on procedural pain during fluoroscopically guided lumbar transforaminal epidural injections: A randomized clinical trial. Am J Phys Med Rehabil 98(4):253–260.
Elson, J A & Paech, M J . 1995. EMLA Cream before Insertion of Elective Epidurals. Anaesth Intensive Care 23(3):339–380.
Gozdemir, M, Demircioglu, R I, Karabayirli, S, Sert, H, Muslu, B, Usta, B & Yazıcı, U . 2016. A Needle-Free Injection System (INJEXTM) with lidocaine for epidural needle insertion: A randomized controlled trial. Pak J Med Sci 32(3).
Bodian, C A, Freedman, G, Hossain, S, Eisenkraft, J B & Beilin, Y . 2001. The Visual Analog Scale for Pain. Anesthesiology 95:1356–61.
Shaikh MM, Attar JR, Khatib S, Deshmukh SN. Comparative study of attenuation of needle prick pain of spinal anaesthesia by local infiltration analgesia versus EMLA skin patch. Perspectives in Medical Research. 2023;11(1):25-29 DOI: 10.47799/pimr.1101.04