Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Topical EMLA Cream as a Pretreatment for Facial Lacerations

  • Park, Sung Woo (Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Oh, Tae Suk (Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Jong Woo (Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Eom, Jin Sup (Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hong, Joon Pio (Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Koh, Kyung S. (Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Taik Jong (Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Eun Key (Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2014.06.10
  • Accepted : 2014.08.14
  • Published : 2015.01.15
Download PDF
⟨ Previous Next ⟩

Abstract

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 ${\geq}16years$ 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.

Keywords

References

  1. Hollander JE, Singer AJ. Laceration management. Ann Emerg Med 1999;34:356-67. https://doi.org/10.1016/S0196-0644(99)70131-9
  2. Singer AJ, Stark MJ. Pretreatment of lacerations with lidocaine, epinephrine, and tetracaine at triage: a randomized double-blind trial. Acad Emerg Med 2000;7:751-6. https://doi.org/10.1111/j.1553-2712.2000.tb02262.x
  3. Priestley S, Kelly AM, Chow L, et al. Application of topical local anesthetic at triage reduces treatment time for children with lacerations: a randomized controlled trial. Ann Emerg Med 2003;42:34-40. https://doi.org/10.1067/mem.2003.207
  4. White NJ, Kim MK, Brousseau DC, et al. The anesthetic effectiveness of lidocaine-adrenaline-tetracaine gel on finger lacerations. Pediatr Emerg Care 2004;20:812-5. https://doi.org/10.1097/01.pec.0000148029.61222.9f
  5. Singer AJ, Stark MJ. LET versus EMLA for pretreating lacerations: a randomized trial. Acad Emerg Med 2001;8:223-30. https://doi.org/10.1111/j.1553-2712.2001.tb01297.x
  6. Young KD. What’s new in topical anesthesia. Clin Pediatr Emerg Med 2007;8:232-9. https://doi.org/10.1016/j.cpem.2007.08.002
  7. Harman S, Zemek R, Duncan MJ, et al. Efficacy of pain control with topical lidocaine-epinephrine-tetracaine during laceration repair with tissue adhesive in children: a randomized controlled trial. CMAJ 2013;185:E629-34. https://doi.org/10.1503/cmaj.130269
  8. Hahn IH, Hoffman RS, Nelson LS. EMLA-induced methemoglobinemia and systemic topical anesthetic toxicity. J Emerg Med 2004;26:85-8. https://doi.org/10.1016/j.jemermed.2003.03.003
  9. Brent AS. The management of pain in the emergency department. Pediatr Clin North Am 2000;47:651-79. https://doi.org/10.1016/S0031-3955(05)70231-5
  10. Rosenthal D, Murphy F, Gottschalk R, et al. Using a topical anaesthetic cream to reduce pain during sharp debridement of chronic leg ulcers. J Wound Care 2001;10:503-5. https://doi.org/10.12968/jowc.2001.10.1.26042
  11. Agrifoglio G, Domanin M, Baggio E, et al. EMLA anaesthetic cream for sharp debridement of venous leg ulcers: a double-masked, placebo-controlled study. Phlebology 2000;15:81-3. https://doi.org/10.1007/s005230070027
  12. Hansson C, Holm J, Lillieborg S, et al. Repeated treatment with lidocaine/prilocaine cream (EMLA) as a topical anaesthetic for the cleansing of venous leg ulcers. A controlled study. Acta Derm Venereol 1993;73:231-3.
  13. Zempsky WT, Karasic RB. EMLA versus TAC for topical anesthesia of extremity wounds in children. Ann Emerg Med 1997;30:163-6. https://doi.org/10.1016/S0196-0644(97)70136-7

Cited by

  1. Pain-management strategies for cosmetic injectable treatments: an overview vol.4, pp.7, 2015, https://doi.org/10.12968/joan.2015.4.7.322
  2. Local anesthesia and anxiolytic techniques for oculoplastic surgery vol.13, pp.None, 2015, https://doi.org/10.2147/opth.s188790
  3. Updates in emergency department laceration management vol.6, pp.2, 2015, https://doi.org/10.15441/ceem.18.018