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Topical anaesthetics are considered a first-line therapy option in men with premature ejaculation (PE). A cross-sectional retrospective analysis was performed to evaluate the real-life use of the eutectic mixture of prilocaine/lidocaine spray (FORTACIN™) in a cohort of 198 white-European men who had been consecutively and prospectively seen at a single tertiary-referral andrology centre for self-reported PE and naive for previous PE treatments. Descriptive statistics was used to describe the whole cohort and the paired t-test was applied to investigate potential differences throughout a 12-month follow-up (baseline, 1, 3, 6 and 12 months). Overall, mean (SD) age was 37 (6.5) years. Of all, lifelong, acquired and subjective PE were reported in 101 (51%), 59 (29.8%) and 38 (19.2%) patients at baseline, respectively. FORTACIN™ use increased up to 6 months, with 184 (92.9%) and 128 (66.4%) men who had tried and regularly used the compound, respectively. At 12-month follow-up, 53 (26.8%) men reported a regular use of the compound. Mean Premature Ejaculation Diagnostic Tool score significantly decreased at 6 and 12 months compared to baseline (all p < 0.05). Conversely, mean IELT significantly improved at 6-month follow-up compared to baseline (all p ≤ 0.04). Overall, FORTACIN™ emerged to be a safe and effective treatment option in PE patients of various types, with almost one fourth of patients still under treatment after 12 months. Timing and dosing of the drug can deserve to be adjusted according to patient's needs and their sexual ecology.

Background: The pain caused by the injection of local anesthetic has been reported as one of the main complaints of dental patients. Topical anesthetics are widely used drugs in dentistry, mainly to control pain associated with the needle penetration in the administration of local anesthesia. Objective: The present study aimed to evaluate (5%,7.5% and 10%) concentrations of lidocaine/prilocaine agent, compared to the common 10% lidocaine hydrochloride spray in the oral cavity. Materials and Methods: This was a split-mouth double-blind, randomized clinical trial pilot study. We randomized 15 patients, ages 35 to 64 years, with American Society of Anesthesiologists I and II with severe chronic periodontitis who were referred to the dental clinic for surgery, to receive 4 topical anesthetics (5%, 7.5%, and 10%) lidocaine prilocaine emulsion and 10% lidocaine hydrochloride topical anesthetic agent before local infiltration. Primary outcomes were assessing drug safety and pain level that measured by assessment of visual analog scale (VAS) scores of pain during LA injection in the first premolar and second molar in each maxillary quadrant in 15 patients corresponding to the posterior superior alveolar nerve (PSA) and secondary outcome was the relationship between age and gender regarding pain perception, and a total of 60 regions were analyzed. Results: Results revealed that there was no statistically significant difference between lidocaine hydrochloride and (5%,7.5% and 10%) lidocaine prilocaine in terms of pain reduction when the 4 different compounds were compared. According to Spearman's rank correlation coefficient and Friedman test, the age and gender of the patients had an insignificant correlation with the anesthetic effects of the four studied solutions. Conclusion: Based on these results, age and gender have insignificant effects on the pain scores and it can be said that the four solutions do not have significant differences regarding their anesthetic effects; also, we did not find any adverse reactions by using 7.5% and 10% lidocaine/prilocaine agent.

OBJECTIVE To compare pain control during vulvar biopsy after either application of 5% lidocaine-prilocaine cream or injection of 1% lidocaine. METHODS In a single-site randomized trial, patients who needed vulvar biopsy on a non-hair-bearing surface were recruited from a gynecologic oncology clinic to compare lidocaine-prilocaine cream (placed at least 10 minutes before biopsy) with lidocaine injection (at least 1 minute prior). A sample size of 53 participants in each arm (N=106) was planned. Pain was recorded using a 100 mm visual analog scale at three time points: baseline, after application of anesthesia, and after biopsy. The primary outcome was highest pain score recorded. Secondary outcomes were pain score at biopsy, patient experience, and tolerability and acceptability. Linear regression was used to compare the primary outcome between arms while controlling for baseline vulvar pain. A convenience analysis was performed in March 2019. RESULTS From October 2018 to March 2019, 38 patients completed informed consent and were randomized. Participants were women with median age of 60 years. Most characteristics between groups were similar. Nineteen were analyzed in the lidocaine-prilocaine group, and 18 were analyzed in the lidocaine injection group. The median highest pain score in the lidocaine-prilocaine group was 20.0 mm vs 56.5 mm in the lidocaine injection group. Controlling for baseline pain, the highest pain score in the lidocaine-prilocaine arm was 25.7 mm lower than in the lidocaine injection arm (95% CI [-45.1 to -6.3]; P

Background Case series have described disruptive histopathologic changes following lidocaine/prilocaine cream anesthetic for biopsies. Methods A study of histopathologic changes was performed following a randomized trial comparing topical lidocaine/prilocaine cream to 1% lidocaine injection anesthesia for vulvar biopsy. Histopathology was reviewed by two independent dermatopathologists blinded to the type of anesthetic. Specimens were scored on six histopathologic criteria described in the literature. Individual scores for each histopathologic feature and the total score across features were compared between the two groups using marginal models with generalized estimating equations. Results Of 37 specimens reviewed, 19 were randomized to lidocaine/prilocaine cream and 18 to 1% lidocaine. Subjects exposed to lidocaine/prilocaine had the following odds of histopathologic changes, relative to lidocaine-exposed subjects: acantholysis (odds ratio 2.48; 95% confidence intervals 0.51, 12.06), clefting (2.42; 0.64, 9.14), pallor/necrosis (1.13; 0.28, 4.50), spongiosis (0.71; 0.18, 2.85), papillary dermal edema (1.17; 0.41, 3.29). Total scores were not significantly different between treatment arms (risk ratio 0.98; 0.71, 1.35). Conclusion This histopathologic analysis of a randomized trial between lidocaine/prilocaine cream and injected lidocaine as anesthesia for vulvar biopsy demonstrates the absence of significant disruptive histologic features secondary to the type of anesthetic. Additional studies in different clinical contexts are warranted. This article is protected by copyright. All rights reserved.

Pain at arteriovenous fistula (AVF) puncture is common in hemodialysis (HD) patients. The purpose of our work is to determine its frequency, to evaluate the efficiency of two techniques: anesthetic cream (Emla™) and cryotherapy, and to compare their efficiency. A prospective and interventional analytical study of HD patients was conducted in our structure. We included all patients with pain at AVF puncture. We evaluated the pain intensity using a visual analogue scale before and after our intervention: Emla™ cream during three consecutive HD sessions, then cryotherapy (ice cubes placed in latex gloves, during 5 min, directly applied on the puncture sites) during three consecutive HD sessions. The statistical analysis was performed using the Epi Info software. Eighty-four patients are undergoing HD in our structure, of which 32 (38%) report pain at AVF puncture. The mean value of the visual analog scale before the puncture was 7.19 ± 1.95 (4-10). Pain decrease was statistically significant for both techniques. Comparative analysis of the two techniques revealed a significant reduction in pain in favor of cryotherapy (P 0.001). The analgesic effect has been proved for both techniques. Cryotherapy provides higher efficiency, with fewer constraints, and could be proposed for the management of pain at AVF puncture.

Background: Acute pain management is a core ethical commitment to medical practice. However, there is evidence to suggest that sometimes infiltrative lidocaine (IL) is not used prior to thoracentesis and abdominocentesis due to the belief that two needles cause greater pain than one. However, topical anesthetics like lidocaine-prilocaine cream (LPC) are painless, easy to use, and have less systemic side effects. Therefore, LPC can be a suitable substitute for medical procedures. Objectives: This study was designed to compare the analgesic effects of LPC with IL in thoracentesis and abdominocentesis. Methods: Patients were divided into two study groups, including individuals seeing a physician for a thoracentesis (N = 36) and those seeing a physician for an abdominocentesis (N = 33). Patients were randomly assigned to the IL (N = 35) or LPC (N = 34) groups for diagnostic and/or therapeutic purposes. The IL group received 100 mg of 2% lidocaine 5 minutes prior to their procedure, whereas the LPC group received 2.5 g of lidocaine-prilocaine cream. The cream was spread over a 20 - 25 cm2 area and occluded with dressing plaster for 30 minutes prior to the procedure. In both study groups, the thoracentesis and abdominocentesis were ultrasound-guided. Results: The findings suggest a non-significant difference between overall pain perception in LPC and IL groups generally, as well as specifically in abdominocentesis and thoracentesis groups. Furthermore, the result remained the same after controlling for confounding variables. The number of attempts to perform successful abdominocentesis was significantly higher in the LPC than IL (P-value = 0.003) group but was not significant in the thoracentesis group (P-value = 0.131). The level of patient satisfaction in the LPC and IL groups were not significantly different (P-value > 0.05). Conclusions: Overall, LPC appears to be an appropriate alternative to IL in reducing pain during thoracentesis and abdominocentesis, but it seemed to increase unsuccessful medical procedure attempts.

Objectives The study aimed to evaluate the efficacy of a eutectic lidocaine/prilocaine cream (EMLA cream; Astra Pharmaceuticals) in reducing pain and reaction to venepuncture during jugular blood sampling in cats after a 30-min topical application time. Methods The study was a prospective, blind, controlled clinical trial. Eighteen healthy client-owned cats were randomly allocated to two study groups. All cats were clipped on the left jugular groove region and then, depending on the study group, either the placebo (liquid paraffin) or EMLA cream was applied to the region. The area was then kept protected for the next 30 mins. Except for the operator who administered the product, all operators were blinded to the study groups. Blood sampling was performed by an experienced operator and a stress score was assigned to each cat according to the reactions observed during the venepuncture. Also, the procedure was classified as being ‘easy’ or ‘difficult’ by the same operator. Results A significantly reduced stress score was observed in cats that received the EMLA cream compared with those belonging to the placebo group ( P = 0.048); withdrawal movements were observed in 1/9 cats treated with the EMLA cream vs 7/9 cats of the placebo group ( P = 0.015). The jugular venepuncture was defined as easy in 1/9 cats that received the placebo and in 8/9 cats in the EMLA group ( P = 0.015). Conclusions and relevance The present study provides evidence for the efficacy of the EMLA cream after a 30-min application time for jugular venepuncture in cats, together with significantly reduced stress for patients. Therefore, this study supports the routine use of EMLA cream as good practice to enhance the welfare of cats and to simplify venepuncture procedures.

Premature ejaculation (PE) is a common complaint of male sexual dysfunction affecting men and their partners and consequently causing significant personal and interpersonal distress. Increased sensitivity of the glans penis and abnormalities of the afferent-efferent reflex pathway within the ejaculatory process are involved in the occurrence of PE. Drugs that either selectively reduce penile sensitization or modify the afferent-efferent reflex are well established therapeutic options for PE. Fortacin™ is the first topical treatment to be officially approved for the treatment of primary PE in adult men, and is mentioned as an experimental aerosol (as TEMPE) in the current European Association of Urology guidelines. It was approved for use in the European Union and launched in the United Kingdom in November 2016. Fortacin™ is a eutectic-like mixture of lidocaine 150 mg/mL and prilocaine 50 mg/mL that meets the requirements of an ideal treatment for PE because it is fast acting (within 5 minutes), has durable effects, can be easily used “on-demand”, and shows minimal side-effects. The metered-dose spray delivery system allows the desensitizing agents to be deposited in a dose-controlled, concentrated film onto the glans penis consequently reducing its sensitivity. This is translated into a delaying of the ejaculatory latency time without adversely affecting the sensation of ejaculation and orgasmic pleasure. The efficacy and safety of Fortacin™ have been proven by means of increased ejaculatory latency, control, and sexual satisfaction in large scale studies demonstrating the significant benefits for both patients and their partners.

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. 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. 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. 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.

Objective The aim of the present study was to assess the level of access site pain in patients undergoing transradial coronary catheterization by using topical application of an anesthetic ointment (lidocaine/prilocaine—AO) compared to standard local anesthesia (LA) by means of injectable lidocaine. Methods We prospectively studied 444 patients undergoing elective trans-radial coronary angiography. The quality of analgesia was assessed using a visual analogue scale (VAS) immediately after the puncture and 30 min after the removal of the sheath. The number and duration of attempts before successful sheath insertion, as well as artery spasm, were compared between the two groups. Results Pain levels measured by VAS were found to be similar between the two groups during sheath insertion (VAS: AO: 4.84 ± 1.0 vs 4.82 ± 1.2, P = NS), as well as 30 min after sheath removal (VAS: AO: 0.07 ± 0.5 vs LA: 0.15 ± 0.6, P = NS). The time to obtain radial access was also not affected by the use of anesthetic ointment (AO: 62.24 ± 25.7 s vs LA: 64.04 ± 18.78 sec, P = NS). The rate of clinical or angiographic radial artery spasm was similar (8-10%) between the groups (P = NS) Conclusion Use of a local anesthetic ointment, versus injectable lidocaine, in trans-radial cardiac catheterization as means of local anesthesia, was found to be equally effective in terms of pain, artery spasm, or artery cannulation speed.

Background Doing and repairing episiotomy in a natural vaginal delivery is a painful phenomenon and various methods have been used to reduce its pain. Nowadays, topical ointments are being increasingly used due to low systemic absorption and ease of use. Objectives The present study aimed to compare the effects of lidocaine-prilocaine cream (XYLA cream) and lidocaine injection on the reduction of pain while doing and repairing episiotomy. Methods This randomized clinical trial was conducted on 98 pregnant women with the gestational age of > 37 weeks. In the intervention group that contained 50 women, 5 gr XYLA cream was applied to the episiotomy area one hour prior to delivery. It was also applied to healthy wound edges to numb the area while repairing episiotomy. In the control group, lidocaine 2% injection was used at the time of delivery. The two groups were compared regarding demographic characteristics, delivery characteristics, pain intensity based on visual analogue scale (VAS), and satisfaction with the applied technique. Results The results showed no significant differences between the two groups with respect to age, occupation, mother's weight and education level, gestational age, parity, number of deliveries, and infant's weight and head circumference (P > 0.05). Also, no significant difference was found between the two groups concerning the length of the active, second, and third phases of labor (P > 0.05). Considering postpartum complications (episiotomy wound infection), the infection was detected in three participants in the XYLA cream group and four individuals in the lidocaine group, but the difference was not statistically significant (P = 0.376). It should be noted that the application of XYLA cream did not cause eye irritation in any of the infants. The results also revealed no significant differences between the two groups regarding pain intensity and satisfaction with the applied technique after doing and repairing episiotomy (P = 0.288). Conclusions The results indicated that XYLA cream had no specific complications and had an effect similar to lidocaine injection while doing the episiotomy.

Objective To compare the reaction to cephalic intravenous (IV) catheter placement with or without lidocaine–prilocaine cream in cats sedated with dexmedetomidine and methadone or nalbuphine. Study design Prospective, randomized, blind study. Animals A group of 24 female mixed breed cats. Methods Cats were randomly allocated to one of the two sedation protocols: dexmedetomidine (0.01 mg kg–1) and methadone (0.3 mg kg–1; DEXMET) or dexmedetomidine (0.01 mg kg–1) and nalbuphine (0.3 mg kg–1; DEXNALB). Sedation was scored 30 minutes later using a visual analog scale. Subsequently, a 2 × 3.5 cm area of the antebrachium over the cephalic vein was clipped, and half the cats within each protocol were randomly assigned for topical lidocaine–prilocaine cream (treatment), whereas no cream was applied to other cats (control). After 20 minutes, an attempt was made to place a 24 gauge catheter into the cephalic vein and the reaction of the cats to this procedure was scored using a numeric scale 0–3. Sedation and catheterization reaction scores were compared between sedation protocols and whether cats were administered lidocaine–prilocaine cream or not using the Friedman test followed by the Bonferroni procedure. A p value Results Sedation scores were not different between sedation protocols or between treatment and control cats within each protocol. All cats administered lidocaine–prilocaine cream showed no reaction to IV catheter placement. Among the control cats, no response was observed in one cat in DEXNALB. Catheterization reaction score was lower in the treatment cats in both the sedation protocols when compared with their respective controls. Conclusions and clinical relevance Lidocaine–prilocaine cream applied for 20 minutes abolished the reaction to catheterization in cats sedated with dexmedetomidine and nalbuphine or methadone. Facilitation of IV catheter placement occurred within 20 minutes of lidocaine–prilocaine application.

Chronic foot and leg ulcers are a common health problem worldwide. A mainstay of chronic ulcer therapy is sharp mechanical wound debridement requiring potent analgesia. In this prospective, controlled, single-centre, crossover design study, patients were assigned to either the administration of topical analgesia with 5% lidocaine/prilocaine cream or the inhalation of an analgesic 50% N2 O/O2 gas premix. Primary outcome parameter was level of pain at maximum wound depth during debridement as measured by a visual analogue scale. Secondary outcomes included level of pain after debridement, overall duration of treatment session, duration and completeness of debridement, and the patient's subjective perception of analgesic quality during debridement. Pain level increased from 0·60/0·94 (first/second debridement; baseline) to 1·76/2·50 (debridement) with 5% lidocaine/prilocaine and from 1·00/1·35 (baseline) to 3·95/3·29 (debridement) with 50% N2 O/O2 gas premix. Patient satisfaction was 90·48%/94·44% (first/second debridement) with topical 5% lidocaine/prilocaine analgesia and 90·48%/76·47% with the inhalation of 50% N2 O/O2 gas premix. Debridement was completed in a significantly higher percentage of 85·71%/88·89% (first/second debridement) with 5% lidocaine/prilocaine than with 50% N2 O/O2 gas premix (42·86%/58·82%) (odds ratio 6·7; P = 0·001). This study provides sound evidence that analgesia with topically administered 5% lidocaine/prilocaine cream is superior to the use of inhaled 50% N2 O/O2 gas premix in chronic leg ulcer debridement.

Objectives To compare the analgesic effect of topical lidocaine-prilocaine (LP) cream and rectal meloxicam suppository on the post-episiotomy pain in primigravidae. Patients and methods A randomized open-label clinical trial included primigravidae delivered vaginally with episiotomy. Eligible women were recruited and randomized to topical LP cream on the episiotomy line or rectal meloxicam suppository 15 mg. The intensity of the perineal pain was assessed using a visual analog scale (VAS) immediately, at 6, 12 h and after 5 days post-episiotomy. Results One hundred ninety women were enrolled (n = 95 in each arm). No difference between both groups in the VAS scores immediately (mean ± SD: 8.54 ± 1.35 vs. 8.33 ± 1.50, p = 0.419) and 6 h after episiotomy (p = 0.859). However, women in the LP arm were more likely to report lower VAS scores at 12 h and 5 days post-episiotomy (mean ± SD: 1.20 ± 0.50 vs. 5.65 ± 1.65, p = 0.0001; 1.19 ± 0.49 vs. 2.64 ± 1.73, p Conclusion Application of topical LP cream after repair of episiotomy in primigravidae seems to substantially alleviate the induced pain with subsequent less need for additional analgesia and more patients’ satisfaction.

CONTEXT: The eutectic mixture of lidocaine (EMLA) cream has been used to reduce the pain during venipuncture in infants. OBJECTIVE: To determine the efficacy and safety of EMLA in infants 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.

Background: Perineal trauma is a common problem that may affect women during vaginal delivery; this trauma can be either spontaneous (tear) or intentional (episiotomy). When repair of perineal trau...

The current study aims to compare the analgesic effect of lidocaine-prilocaine (LP) cream with lidocaine infiltration during repair of perineal tears after vaginal delivery.A single center open-labeled randomized clinical trial was carried out in a tertiary University Hospital between October 2016 and May 2017 (Clinical Trials.Gov: NCT02883179). We included parous women, who delivered at gestational age37 weeks with first- or second-degree perineal tears. The participants were randomized in a 1:1 ratio to either lidocaine infiltration (Group I); or application of LP cream (Group II) for pain relief during perineal repair. The primary outcome was the difference in mean pain score during perineal repair. Secondary outcomes included the participants' satisfaction, the need for additional anesthesia, the duration of perineal repair, and the rate of adverse effects of both medications.The study included 144 participants randomized to both groups. The mean pain score during perineal repair was significantly lower in the LP cream group (3.86 ± 1.59) than the lidocaine infiltration group (5.99 ± 1.47) [p = .001]. The duration of repair was significantly shorter in the LP group than the lidocaine infiltration group (6.37 ± 3.68 versus 8.17 ± 2.75 min, respectively, p = .001). The need for additional anesthesia was quite similar in both groups (p = .371). More women in the LP cream group were satisfied than the other group with statistical significant difference (76.4 versus 30.6%, p = .000). No difference between side effects in both groups (p = .171) Conclusions: Topical application of lidocaine-prilocaine cream is an effective analgesic during repair of perineal tears with no harmful side effects.

The aim of this study was the evaluation of the practical use of lidocaine/prilocaine cream as the local anaesthetic in combination with tramadol anaesthesia for the surgical treatment of prolapsed penis in chelonians. Eighteen animals were included in this study. After administration of tramadol, prolapsed penis was cleaned and disinfected. Lidocaine/prilocaine cream at a dose of 1g/10 cm 2 was applied on the penile mucosa. The time interval from lidocaine/prilocaine application to a loss of hind limb withdrawal reflex and the response to penile mucosa pinching was recorded as the induction time for surgical anaesthesia. The time interval from lidocaine/ prilocaine application to full restoration of tail and hind limb withdrawal reflex was recorded as the recovery time. In two male chelonians the response to pain stimuli persisted for more than 20 min after lidocaine/prilocaine cream application, and the anaesthetic cream had to be re-administered. After this second application of lidocaine/prilocaine cream, surgical anaesthesia was reached within 28 and 32 min. The mean induction time for surgical anaesthesia was 19.22 ± 4.36 min. The mean recovery time was 40.83 ± 7.68 min. In all 18 male chelonians the surgical treatment of prolapsed penile was uneventful. Topical application of lidocaine/prilocaine cream can be used as a feasible form of local anaesthesia in combination with tramadol analgesia management for minor surgical procedures in chelonians. Reptiles, terrapins and tortoises, pain, minor surgery

Objective The efficacy of lidocaine–prilocaine cream (EMLA ® ) analgesia in the practice of hysterosalpingography is controversial. This study provides new drill results and a new method of application in terms of mode, time and place. The aim of the paper is to investigate the efficacy of 5% lidocaine 25 mg–prilocaine 25 mg/g cream applied to the uterine cervix for reducing pain during hysterosalpingography. Study design A randomized, double blinded, controlled study set in the general gynaecology clinic of a university teaching hospital between September 2012 and June 2013. One hundred successive patients programmed to undergo hysterosalpingography were randomized to either 3 ml of EMLA (50) cream or 3 ml of placebo (50), placed endocervically and exocervically, 10 min before hysterosalpingography. Patients’ intensity of pain was assessed in four steps: at baseline (speculum application), after application of Pozzi tenaculum and cannula on the uterine cervix, during cervical traction and after contrast medium injection, using a 10-cm Visual Analogue Scale (VAS) immediately after the procedure. The most painful step was also identified. VAS was administered again at one-month follow-up visit. Trial registration: NCT01303614. Results The contrast medium injection was the most painful step of hysterosalpingography in both groups (EMLA 3.96, placebo 4.54, 95%CI: −0.481 to 1.641). No differences were found between the two groups ( P = 0.281) during this step. When comparing the VAS scale after the application of Pozzi tenaculum and cannula (EMLA 1.06, placebo 3.34, 95%CI: 1.495–3.065) and after cervical traction (EMLA 2.54, placebo 3.46, 95%CI: 0.034–1.806), significantly less pain was experienced by the EMLA group than the placebo group: P = 0.000 and P = 0.042, respectively. Conclusion Endocervical and exocervical topical application of EMLA 10 min before performing hysterosalpingography significantly reduced pain during cervical manipulation with tenaculum and cannula and during cervical traction, but did not reduce pain during injection of contrast that was the most painful step.

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.

Background The initial placement of orthodontic elastomeric separators can be uncomfortable and painful. Therefore, it is important to relieve this disturbing sensation to create a discomfort or pain-free orthodontic visit. The purpose of this study was to investigate the effect of a lidocaine/prilocaine topical anesthetic on pain and discomfort associated with the placement of orthodontic elastomeric separators. Methods Fifty subjects aging between 20–35 years were included in this study. In the maxillary arch, a lidocaine/prilocaine topical anesthetic was placed around the ginigval margins of the premolar and molar on side. On the other side, a placebo agent was placed around the ginigval margins of the premolar and molar. After two minutes, an elastomeric separator was placed between the premolar and molar on both sides. The subjects were then asked to report their findings on a Verbal Scale and a Visual Analogue Scale every second minute for a period of 10 min. The subjects were also given a questionnaire to evaluate the overall impression on the topical anesthetic use. Results The overall mean discomfort/pain score was found to be significantly lower (p

A 12-day-old boy presented with duskiness 4 h after circumcision with local anesthesia: infiltration with lidocaine (6 mL 1 %) and topical EMLA cream (2.5 % lidocaine/2.5 % prilocaine). He had no respiratory distress, but a strikingly dark skin. A blood sample showed dark, chocolate brown blood with a raised methemoglobin of 49.8 % (normal

Objective The objective was to investigate the analgesic effect of cervical lidocaine–prilocaine (LP) cream in alleviating pain during copper T380A intrauterine device (IUD) insertion among parous women. Study design We conducted a randomized, double-blind, placebo-controlled trial at Assiut Women's Health Hospital, Egypt, from October 2015 to April 2016 of parous women desiring copper IUD insertion. We randomized the subjects in a 1:1 ratio to LP cream or placebo. Seven minutes prior to IUD insertion, women received 2 ml of LP cream or placebo to the anterior cervical lip, followed by 2 ml placed in the cervical canal using a Q-tip applicator. The study end point was the subjects' self-reported pain using a 10-cm visual analog scale (VAS) during cervical tenaculum placement, sound insertion, IUD insertion and 5 min postprocedure. We considered a 2-cm difference in VAS scores between study groups as clinically significant. Also, the difference in the ease of insertion score using a 10-cm VAS with 0=very easy insertion and 10=terribly difficult insertion was assessed. Results The study included 120 women ( n =60 in each group). LP cream reduces the median VAS pain scores during tenaculum placement (2 vs. 4), sound insertion (3 vs. 6) and IUD insertion (3 vs. 6.5) with p=.0001 at all steps. A lower ease of insertion score was also determined among LP women (2.5±0.98 vs. 4.5±2.7, p=.001). Participants reported no side effects. Conclusions Use of cervical LP cream prior to copper T380A IUD insertion may alleviate the IUD insertion pain among parous women. Implications Cervical LP cream could be effective as an analgesic prior to copper T380A IUD insertion with no side effects. Further studies are needed to assess the women's satisfaction from lying with a speculum in place for 7 min while waiting for the cream to be effective.

Background: Mammography (MG) is an important imaging method in the diagnosis of breast diseases. However, pain during MG is an uncomfortable factor for the majority of women. Aim: The aim of this study is to determine the effectiveness of lidocaine/prilocaine cream on reducing pain during mammography. Methods: This is a prospective clinical study. A total of 60 female patients who had mammographic examination were equally divided into three groups; patients receiving 10 g EMLA cream (EMLA group), patients receiving 10 g Bepanthen cream (placebo group), and patients not receiving any cream (control group). Pain levels were assessed by using visual analogue scale (VAS) before and after MG. RESULTS: Each group was statistically similar in terms of basic patient characteristics. There was also no significant difference between the pre-MG VAS scores of the three groups (p = 0.996). On the other hand, VAS scores during MG was found significantly different between the groups (p = 0.001). When the groups were compared in pairs, the patients in EMLA group had significantly less post-MG VAS score than the Bepanthen and control groups (p = 0.001). There was no significant difference between Bepanthen and control groups (p = 0.678). CONCLUSION: To our knowledge, this is the first study demonstrating that a topical anaesthetic, EMLA, provides an effective analgesia during MG. Reducing the pain can change women’s preconceptions regarding MG.

Background: Pain is a common adverse effect of dermatological laser procedures. Currently, no standard topical anaesthetic cream exists for deeper dermal laser procedures. Objectives: To compare the efficacy of lidocaine/tetracaine cream and lidocaine/prilocaine cream in reducing self-reported pain during deeper dermal laser treatment of acne keloidalis nuchae (AKN) and tattoos. Methods: We conducted two randomized, double-blind, controlled clinical trials with intrapatient, split-lesion designs: study A included patients with AKN (n = 15); study B included patients with black tattoos (n = 15). The primary end point was the patients' self-reported pain on a 10-cm visual analogue scale (VAS). Secondary objectives were the percentage of patients with adequate pain relief, willingness to pay €25 for the cream that provided the best pain relief and safety of the creams. Results: In both studies, VAS scores were lower for lidocaine/prilocaine cream, with a mean VAS difference in study A of 1·9 [95% confidence interval (CI) 1·0-2·8] and in study B of 0·6 (95% CI -0·7 to 1·9). In study A, adequate pain relief was achieved in 13% (n = 2) with lidocaine/tetracaine cream vs. 73% (n = 11) with lidocaine/prilocaine cream (P = 0·004), and in study B in 53% (n = 8) vs. 80% (n = 12), respectively (P = 0·289). In study A, 47% (n = 7) were willing to pay an additional €25 vs. 73% (n = 11) in study B. No serious adverse events occurred. Conclusions: Lidocaine/prilocaine cream under plastic occlusion is the preferred topical anaesthetic during painful laser procedures targeting dermal chromophores.

What's known on the subject? and What does the study add? Study Type – Harm Reduction RCT Level of Evidence 1b The combination of perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block effectively counteracts probe and sampling related pain during transrectal prostate biopsy, but not pain due to periprostatic infiltration. The novel combination of lidocaine-prilocaine cream and lidocaine-ketorolac gel, both administered perianal-intrarectally, provides the same probe and sampling-related pain relief than combined perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block and prevents the non-negligable pain due to periprostatic infiltration, thus leading to better overall patients' compliance to the procedure. OBJECTIVE • To compare the efficacy and safety of combined perianal-intrarectal (PI) lidocaine-prilocaine (LP) cream and lidocaine-ketorolac (LK) gel with combined PI LP cream and periprostatic nerve block (PPNB) in relieving pain during transrectal ultrasonography guided prostate biopsy (TPB). PATIENTS AND METHODS • In all, 200 patients were randomized to receive combined PI LP cream and LK gel (group 1) or combined PI LP cream and PPNB (group 2) before TPB. • The 0–10-point visual analogue scale (VAS) was used for assessing pain at probe insertion and movements (VAS-1), periprostatic infiltration (VAS-2) when applied, and prostate sampling (VAS-3), as well as maximal procedural pain (MPP). • Complications occurring ≤20 days after the TPB were recorded. RESULTS • The groups were comparable for patients' age, serum PSA level, prostate volume, and cancer detection rate. • All patients tolerated the procedure well. The two anaesthetic regimens provided almost equal mean VAS-1 (0.33 vs 0.37; P= 0.701) and VAS-3 (0.52 vs 0.51; P= 0.954) scores, but patients in group 2 reported significantly greater MPP scores (0.68 vs 1.53; P < 0.001) as periprostatic infiltration was the most painful part of the procedure (mean VAS-2: 1.33). • Complications rate was similar in the two groups (1% vs 2%; P= 0.38). CONCLUSIONS • The novel combination of PI LP cream and LK gel provided the same probe- and sampling- related pain relief as combined PI LP and PPNB; moreover, by preventing the non-negligible periprostatic infiltration pain, it provided significantly better overall patients' compliance to the procedure. • Being safe and easy to administer, this novel non-infiltrative regimen has the potential to replace infiltrative anaesthesia in relieving pain during TPB.

OBJECTIVE: The goal of this study was to compare the analgesic effect of sucrose with that of the combination of sucrose and the local anesthetic cream EMLA during venipuncture in preterm neonates. METHODS: This randomized, double-blind prospective study included infants younger than 37 weeks' gestational age during 1 routine venipuncture for blood sampling. Each child randomly received either sucrose plus application of a placebo cream (S group) or sucrose plus EMLA cream (S+E group) before venipuncture. Venipuncture-induced pain was assessed through videotapes of the procedures by using the Douleur Aiguë Nouveau-né (DAN) behavioral scale. Pain was assessed at 2 phases: during venipuncture (from needle introduction to its removal) and during the recovery period (30 seconds after needle removal). Pain scores over time and between treatments were compared by using repeated-measures analysis of variance. RESULTS: The study included 76 children (37 in the S group, 39 in the S+E group). Mean (SD) DAN pain scores for the S group and the S+E group were 7.7 (2.1) and 6.4 (2.5), respectively, during venipuncture and 7.1 (2.8) and 5.7 (3.3) during the postinjection period. A significant time and treatment effect in favor of the S+E group was observed. CONCLUSION: The combination of sucrose and EMLA cream revealed a higher analgesic effect than sucrose alone during venipuncture in these preterm infants.

Background Mechanical debridement of fibrin and/or necrosis promotes healing of arterial and venous leg ulcers but is limited by pain associated with the procedure. Objective The main objective of this study was to compare the respective analgesic effect of nitrous oxide oxygen mixture (NOOM) inhalation and lidocaine–prilocaine cream (LPC) application during the mechanical repeated debridement of chronic arterial and venous leg ulcers. Methods In this randomized, multicentre, open-label study, pain was evaluated before and after each care and debridement session using a Visual Analog Scale (VAS) and a Verbal Rating Scale (VRS), in the context of usual debridement and wound care process. The Quality of debridement and tolerability of the treatments were also assessed. Results Forty-one patients were randomized: 20 received NOOM and 21 LPC. Pain assessed by VAS and VRS was more intense in the NOOM group than in the LPC group (5.29 vs. 3.68 and 2.87 vs. 1.71, P

Die Ejaculatio praecox (EP) ist mit Pravalenzraten von 20–25% die haufigste Sexualstorung des Mannes. Wahrend fur die lebenslange EP genetisch determinierte Veranderungen im Serotoninrezeptor-/-transportermechanismus verantwortlich zu sein scheinen, ist die erworbene EP oftmals mit anderen konditionierenden Erkrankungen wie erektile Dysfunktion, Prostatitis oder Schilddrusenstorungen assoziiert. Die EP ist gekennzeichnet durch eine kurze intravaginale Ejakulationslatenzzeit (IELT) von

To our knowledge the optimal analgesia during prostate biopsy remains undetermined. We tested the efficacy and safety of combined perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block during transrectal ultrasound guided prostate biopsy.A total of 280 patients were randomized to receive combined perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block (group 1), perianal-intrarectal lidocaine-prilocaine cream alone (group 2), periprostatic nerve block alone (group 3) or no anesthesia (group 4) before transrectal ultrasound guided prostate biopsy. Pain was evaluated with a 10-point visual analog scale at subsequent procedural steps, including perianal-intrarectal substance administration, prostate transrectal ultrasound, periprostatic nerve block and sampling. Complications were assessed by self-administered questionnaire and telephone interview.The groups were comparable in patient age, prostate volume, pathology results and visual analog scale perianal-intrarectal substance administration. Visual analog scale results for transrectal ultrasound were lower in groups 1 and 2 vs 3 and 4 (mean 1.5 and 1.41 vs 5.37 and 5.31, p0.001) and results for periprostatic nerve block were lower in group 1 vs 3 (mean 1.03 vs 3.74, p0.001). Results for sampling were lower in groups 1 to 3 vs 4 (mean 0.77, 1.27 and 1.27 vs 4.33, p0.001) and in group 1 vs 2 and 3 (p0.001). Stratified analysis showed that visual analog scale sampling was lower in group 1 vs 2 and 3 in patients 65 years old or younger, those with a prostate greater than 49 cc and those with lower anorectal compliance (visual analog scale results for perianal-intrarectal substance administration greater than 2) (p = 0.006,0.001 and 0.003, respectively). The overall complication rate was similar in all 4 groups (p = 0.87).Our findings suggest that the combination of perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block provides better pain control than the 2 modalities alone during the sampling part of transrectal ultrasound guided prostate biopsy with no increase in the complication rate. The magnitude of this effect is higher in younger men, men with a larger prostate and men with lower anorectal compliance.

Aims: To determine the optimal place to apply the local anesthetic agent and to investigate the efficacy of lidocaine-prilocaine cream on the perianal and intrarectal region during prostate biopsy. Methods: The study included 80 patients. Patients were randomized into four groups: group 1 served as the control group and was administered no anesthesia; group 2 received 5 ml lidocaine-prilocaine cream perianally; group 3 received 5 ml lidocaine-prilocaine cream intrarectally, and group 4 received lidocaine-prilocaine cream perianally and intrarectally. Pain scores during probe insertion, biopsy procedure, and the overall pain score were assessed. Mean pain scores in each group were compared statistically. Results: In group 1, the mean pain score was significantly higher during probe insertion than that during biopsy (p < 0.001). For the mean overall pain scores, there was no significant difference between groups 1 and 3 (p = 0.942), but the results of group 1 were statistically different from groups 2 (p = 0.001) and 4 (p < 0.001). When we compared the biopsy pain scores, there was no significant difference among the groups (p > 0.05). During probe insertion, subjects in groups 2 and 4 reported significantly lower pain scores than the control group (p = 0.002, p = 0.001, respectively). Conclusions: Perianal anesthesia with lidocaine-prilocaine cream may solely be sufficient to decrease the pain during prostate biopsy.

OBJECTIVE. Palivizumab (Synagis [Abbot Laboratories, Kent, United Kingdom]) is recommended for the prevention of severe lower respiratory tract infections caused by respiratory syncytial virus in infants at high risk. These injections are very painful, and currently the use of analgesics is not systematic. The objective of this study was to compare the efficacy of EMLA with premixed 50% nitrous oxide/oxygen, used alone or combined with EMLA, for pain alleviation during palivizumab injections.METHODS. This randomized, double-blind, multicenter study included children who were younger than 24 months. Each child randomly received during the first 3 monthly injections 3 different analgesic interventions: (1) EMLA: application of EMLA plus air inhalation; (2) nitrous oxide/oxygen: inhalation of 50/50 nitrous oxide/oxygen plus application of a placebo cream; and (3) nitrous oxide/oxygen plus EMLA: inhalation of 50/50 nitrous oxide/oxygen plus application of EMLA. Each child was his or her own control. Procedural pain was assessed through videotapes with the Modified Behavioral Pain Scale. The procedure itself was subdivided in 2 periods: (1) injection and (2) recovery (first 30 seconds after the removal of the needle). Modified Behavioral Pain Scale scores over time (injection and recovery periods) and among treatments were compared by repeated-measures analysis of variance.RESULTS. Fifty-five children were included. Mean ± SD Modified Behavioral Pain Scale pain scores for EMLA, nitrous oxide/oxygen, and nitrous oxide/oxygen plus EMLA were, respectively, 9.3 ± 1.0, 8.8 ± 1.2, and 8.2 ± 1.8 during the injection and 7.8 ± 1.7, 7.4 ± 1.9, and 6.9 ± 2.4 during the recovery period. A significant time and treatment effect in favor of the combined nitrous oxide/oxygen plus EMLA was observed.CONCLUSIONS. The administration of 50/50 nitrous oxide/oxygen to infants and young children is effective in decreasing the pain associated with palivizumab intramuscular injections. The combined nitrous oxide/oxygen plus EMLA cream was more effective than either EMLA cream or nitrous oxide/oxygen alone.

Background Amitriptyline is effective in relieving neuropathic pain. Its site of action is thought to be supraspinal and spinal, but a peripheral effect on fibers is also suggested. Methods This double-blind study examined the effects of transcutaneous amitriptyline diluted in hydroalcoholic solution in healthy young male volunteers. Six treatments were randomly applied on different areas of the skin of the back: amitriptyline at 0 (vehicle), 25, 50, and 100 mm; saline (control); and lidocaine-prilocaine cream as a positive control. Up to 24 h after application, mechanical thresholds for touch and nociception, and thermal thresholds for cold, warm, and heat sensation were recorded for each area. Blood samples were collected to assess plasma levels of amitriptyline. A late recording of the tactile thresholds was performed 1 and 3 weeks after the treatment session. Results The thresholds for all sensations did not differ between the vehicle and saline. Lidocaine-prilocaine cream displayed a short-lasting anesthetic effect for all sensations, although this was not significant for warm sensation. Amitriptyline, at the three concentrations studied, induced a mild and short-lasting increase of the tactile and mechanical nociceptive thresholds. It significantly decreased cold thresholds (down to 21.8 degrees C, P = 0.01 vs. 27.5 degrees C for control) and heat thresholds (down to 40.1 degrees C, P = 0.004 vs. 43.4 degrees C for control). These two effects were no longer significant after the fourth hour of observation. Amitriptyline did not change warm thresholds. There was no apparent systemic absorption effect of the drug. Conclusion It is hypothesized that amitriptyline has a differential effect on different fiber structures.

BACKGROUND. Immunization pain is a global public health issue. Despite an abundance of data that demonstrate the efficacy of local anesthetics for decreasing immunization pain, their adoption in practice has not been determined. Our objective was to evaluate analgesic use during childhood immunization.PATIENTS AND METHODS. We used a cluster-sampling survey of pediatricians in the greater Toronto area (who administer immunizations) and multiparous women. By using a self-administered survey, pediatricians reported frequency of analgesic use in their practice for 2 phases of immunization: injection (needle puncture and vaccine administration) and postinjection (hours to days postvaccination). By using an interviewer-administered face-to-face survey, mothers reported analgesic practices for their children.RESULTS. Of 195 eligible pediatricians, 140 (72%) responded. During the injection phase, 58% rarely or never used analgesics compared with 11% for the postinjection phase. During injection, the local anesthetics lidocaine-prilocaine and tetracaine were used at least sometimes in 12% and 2% of the practices, respectively, whereas acetaminophen and ibuprofen were used in 81% and 46%, respectively. Postinjection, acetaminophen and ibuprofen were used in 89% and 56% of practices. Of 257 eligible mothers, 200 (78%) participated. During injection, analgesics were used in 25% of immunizations (acetaminophen [87%], ibuprofen [7%], and lidocaine-prilocaine [6%]). Postinjection, analgesics were used in 33% of immunizations (acetaminophen [86%] and ibuprofen [14%]).CONCLUSIONS. A minority of pediatricians and mothers use topical local anesthetics during childhood immunization despite evidence to support their use. Oral analgesics are used more commonly, but this practice is not consistent with scientific evidence. Knowledge-translation strategies are needed to increase the use of local anesthesia.

Background Many invasive medical procedures cause pain in neonates. Pain in this age group increases morbidity, impairs emotional bonding, and causes hyperalgesia. Combination of lidocaine and prilocaine cream is one of the topical analgesics that are easy to use and safe for neonates. Objective To assess the efficacy of lidocaine-prilocaine combination cream in reducing pain caused by intramuscular injection of hepatitis B and to find out the correlation of sex, gestational age, birth weight, chronological age, and method of delivery with infant’s pain response. Methods A double blind randomized controlled trial was conducted on term neonates. Subjects were selected consecutively and every subject was randomized to either receive lidocaine- prilocaine cream or placebo one hour prior to administration of intramuscular hepatitis B vaccine. The administration was recorded by a handycam and the intensity of pain responses was evaluated using DAN (Douleur Aigue Nouveau-ne) scale. Results Of 67 subjects, the mean of DAN scale was 7.60 (95% CI 7.27;7.95) in the lidocaine-prilocaine cream group and this was significantly lower (P

Introduction: Copper IUD is a long term and reversible contraception which equals tubal ligation in terms of sterilization. One of the barriers to using this contraception method is the fear and the pain associated with its insertion. Eutectic mixture of local anesthetics (EMLA) 5% is a local anesthetic that contains 25 mg lidocaine and 25 mg of prilocaine per gram. Application of topical analgesic cream to the cervix for laser surgery, hysteroscopy and hysterosalpingography is known Aims: this study aimed to determine the effect of EMLA on IUD insertion pain. Methods: This triple blind clinical trial was conducted on 92 women in a clinic in Hamedan in 2012. After applying the cream on the cervix, pain in three steps, after using Tenaculum, after inserting hystrometr and after inserting IUD and removing IUD insertion tube were assessed with visual analog scale and were compared in EMLA group and placebo group Statistical analysis used to determine and compare the pain of independent t tests, Mann-Whitney U test and repeated measures analysis of variance and chi-square tests to determine the homogeneity of variables and Fisher’s exact test was used Results: Insertion hystrometr was determined as the most painful IUD insertion. The mean pain at step 2 (inserting hystrometr) was (3/11±2/53) in EMLA group, (5/23±2/31) in placebo group. EMLA cream significantly reduced the pain after using tenaculum (P

As many as 96% of patients report some kind of discomfort/pain during transrectal ultrasonography (TRUS)-guided prostate biopsy, and when pain is severe, it may be necessary to decrease the planned number of biopsies or interrupt the procedure. Various modalities have been recommended to alleviate the pain, but reports on efficacy are contradictory. We assessed the possible benefit of intrarectal and perianal lidocaine-prilocaine (EMLA) cream.A series of 98 patients without active anal and prostatic conditions underwent TRUS and, 10 to 31 days later, TRUS-guided biopsy. They were asked to grade their discomfort/pain using a 10- point linear visual analog pain scale (VAS). After TRUS, patients were divided into three groups on the basis of the VAS scores. Group 1 (N = 8) had pain scoresor=2 (mild pain/discomfort). Group 2 (N = 75) had pain scores between 2 and 5 (moderate pain/discomfort). Group 3 (N = 15) had pain scoresor=5 (severe pain/discomfort). Each group was then randomized to receive local anesthesia with intrarectal and anal EMLA cream (subgroup A) or intrarectal and anal ultrasound gel as placebo (subgroup B). Pain scoring was repeated after the biopsy.In group 1, there were no significant differences in pain scores between subgroups A and B. In group 2, we could not complete the biopsy in one patient of subgroup B. A statistically significant difference was noticed between the VAS scores of subgroup A and subgroup B (P0.0001). In group 3, we were not able to complete biopsy in 5 patients of subgroup B. We noticed significantly higher VAS scores in subgroup B between TRUS and prostate biopsy (P0.0001), whereas similar scores were observed in subgroup A (P = NS). A statistically significant difference (P0.0001) was noticed between subgroup A and subgroup B scores during biopsy.In patients with high tolerance for simple TRUS, needle trauma does not significantly alter tolerability, and anesthetic provides little benefit for prostatic biopsy. However, the opposite is true in patients presenting moderate to significant pain/discomfort at TRUS, who may benefit from intrarectal/anal administration of EMLA during prostate biopsy.

EMLA is a lidocaine/prilocaine cream used for topical analgesia in human pediatric patients. The purpose of this study was to establish the safety of EMLA in clinically ill cats, to measure systemic absorption and to determine whether EMLA reduced the need for sedation for the placement of jugular catheters. Thirty-one cats were randomized to either a placebo or EMLA cream group. Cream was applied to a 10 cm2 area over the jugular vein, with 1 h of occlusive dressing. Neither anesthetic was systemically absorbed in any cat, and no adverse clinical signs were observed. Struggling during catheter placement was less in the EMLA-treated cats compared to placebo, but did not reach significance ( P=0.06). Jugular catheters were successfully placed in 60% of EMLA-treated cats and 38% of placebo cats; this difference was not statistically significant and may not justify the added steps of EMLA cream administration for this purpose. However, EMLA does appear to be safe in clinically ill cats, and may be useful for other applications such as for skin mass removal or repeated venepuncture.

Background The aim of this study was to develop stable and easily injectable lipid depot preparations of local anesthetics in which the drug concentration can be varied according to desired duration of action. Methods The formulations contained a 2.0, 5.0, 10, 20, 40, 60, 80, or 100% eutectic mixture of lidocaine and prilocaine base in medium-chain triglyceride. Duration of sciatic nerve block and local neurotoxicity was investigated in rats with 2.0% lidocaine:prilocaine HCl solution and 99.5% ethanol as controls. The rate of release of local anesthetic from the site of administration and the possibility to predict in vivo depot characteristics from in vitro release data were investigated for the 20 and 60% formulations. Results The duration of sensory sciatic block was prolonged 3 times with the 20% formulation and approximately 180 times with the 60% formulation, in comparison with the 2% aqueous solution. With the 80 and 100% formulations, all animals still showed nerve block after 2 weeks. The in vivo release of local anesthetic could be approximately predicted from in vitro data for the 20% but not for the 60% formulation. The formulations of 60% or greater and ethanol showed neurotoxic effects. Conclusions The pharmaceutical properties of these formulations compare favorably with those of other depot preparations. The high-percentage ones showed the longest duration of action yet reported for sciatic nerve block in rats. The possibility of using a high-concentration local anesthetic depot formulation as an alternative to ethanol or phenol for long-term nerve blocks in chronic pain merits further investigation.