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Korean J Anesthesiol > Volume 54(4); 2008 > Article
Korean Journal of Anesthesiology 2008;54(4):395-399.
DOI: https://doi.org/10.4097/kjae.2008.54.4.395   
The Analgesic Efficacy of a 5% Eutectic Mixture of Lidocaine and Prilocaine Prior to Insertion of Spinal and Epidural Block.
Yeon Jae Kim, Mi Hwa Jung, Young Ryong Choi, Hue Jung Park, Rim Soo Won, Jin Young Lee, Jin Kyung Jung
1Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Seoul, Korea. leejy7035@yahoo.co.kr
2Department of Anesthesiology and Pain Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
Abstract
BACKGROUND
We evaluated the analgesic efficacy of a 5% eutectic mixture of lidocaine and prilocaine (EMLA(R)) topically applied before performing skin puncture for spinal or epidural anesthesia.
METHODS
The patient population consisted of 75 ASA physical status 1 and 2 adults scheduled for operations of the lower abdominal region, the perineal region or the lower extremities. The patients were randomly allocated to one of five groups of equal size: group A - topical application of EMLA(R) cream 120 min before spinal block; group B - subcutaneous infiltrationof 2 ml of 2% lidocaine immediately before spinal block; group C - no pretreatment before spinal block; group D - topical application of EMLA(R) cream 120 min before epidural block; and group E - subcutaneous infiltration of 2 ml of 2% lidocaine immediatelybefore epidural block. Pain experienced during the whole procedure was rated using a 10 cm visual analogue scale.
RESULTS
Patients in group A experienced less pain compared with those in groups B and C (2.0 +/- 1.9 cm vs 4.1 +/- 1.9 cm and 3.9 +/- 2.2 cm, respectively; P < 0.05). However there was no significant difference between group D and group E (3.6 +/- 2.4 cm vs 4.1 +/- 2.5 cm). The patients in group A and group D were highly satisfied with the method of analgesia (P < 0.05).
CONCLUSIONS
EMLA(R) cream is an effective alternative to subcutaneous infiltration of local anesthetic for analgesia during skin puncture using a 25 G spinal needle. It provides insufficient analgesia however for epidural anesthesia.
Key Words: epidural anesthesia; eutectic mixture of lidocaine and prilocaine; infiltration; lidocaine; spinal anesthesia
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