Download PDF
CC BY-NC-ND 4.0 · Avicenna J Med 2022; 12(04): 178-181
DOI: 10.1055/s-0042-1758389
Brief Report

Comparison of EMLA Cream versus Lidocaine Injection for Lumbar Puncture Pain Control in Pediatric Oncology Patients

Andrea D. Merry-Sperry   *
1   Department of Pediatrics, West Virginia University-Charleston/Charleston Area Medical Center, Charleston, West Virginia, United States
,
Elham Alqudah   *
1   Department of Pediatrics, West Virginia University-Charleston/Charleston Area Medical Center, Charleston, West Virginia, United States
,
Alexa Magner
2   School of Medicine, West Virginia University, Medicine, Morgantown, West Virginia, United States
,
Stephanie Thompson
3   Institute for Academic Medicine Charleston Area Medical Center, Charleston, West Virginia, United States
,
Pamela Smith
4   Department of Pediatric Hematology/Oncology, West Virginia University-Charleston/Charleston Area Medical Center, Charleston, West Virginia, United States
,
Ashley Meyer
4   Department of Pediatric Hematology/Oncology, West Virginia University-Charleston/Charleston Area Medical Center, Charleston, West Virginia, United States
,
Mohamad Badawi 
4   Department of Pediatric Hematology/Oncology, West Virginia University-Charleston/Charleston Area Medical Center, Charleston, West Virginia, United States
› Author Affiliations Funding No sponsorship or funding received.
› Further Information
   Permissions and Reprints

Abstract

Background Subcutaneous lidocaine injection and topical EMLA cream are both used to control lumbar puncture (LP) pain; however, local analgesia usage is not standardized.

Methods We conducted a prospective, single-blinded, randomized-controlled crossover trial comparing the two modalities in reducing LP pain. Pediatric patients requiring serial LPs were randomly assigned to receive EMLA cream or lidocaine injection prior to LP. On the subsequent LP, analgesia was defaulted to the other agent. Pain was assessed using the Wong-Baker FACES Pain Rating Scale pre-procedure: 30 to 60 minutes post-LP, and 24 hours post-procedure.

Results Ten patients were included in the analysis (median age: 5.5 years). Pain ratings at 1 and 24 hours post-LP did not differ between the two strategies (p = 0.79). No adverse local reactions were reported for either agent.

Conclusion Accordingly, both lidocaine and EMLA cream provided effective LP pain control.

Keywords

pain control - lumbar puncture - pediatric oncology - EMLA cream - lidocaine

Note

The protocol was approved by our Institutional Review Board and registered at clinicaltrials.gov (NCT04003012). Link: https://clinicaltrials.gov/ct2/show/NCT04003012.


Manuscript authors included Andrea D Merry-Sperry DO, Elham Alqudah MD, Alexa Magner, Stephanie Thompson PhD, Pamela Smith APRN, Ashley Meyer DO, and Mohamad Badawi MD with each contributing to the conceptualization and design the study as well as data analysis or manuscript preparation. All authors have reviewed and agreed upon the final manuscript content. This manuscript has not been submitted elsewhere nor been previously published.


All authors declare that there are no financial interests, or other relationships of a commercial nature to disclose.


* These authors contributed equally




Publication History

Article published online:
21 December 2022

© 2022. Syrian American Medical Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Gorchynski J, McLaughlin T. The routine utilization of procedural pain management for pediatric lumbar punctures: are we there yet?. J Clin Med Res 2011; 3 (04) 164-167
    PubMedGoogle Scholar
  • 2 Zeltzer LK, Altman A, Cohen D, LeBaron S, Munuksela EL, Schechter NL. American Academy of Pediatrics report of the subcommittee on the management of pain associated with procedures in children with cancer. Pediatrics 1990; 86 (5 Pt 2): 826-831
    CrossrefPubMedGoogle Scholar
  • 3 Carraccio C, Feinberg P, Hart LS, Quinn M, King J, Lichenstein R. Lidocaine for lumbar punctures. A help not a hindrance. Arch Pediatr Adolesc Med 1996; 150 (10) 1044-1046
    CrossrefPubMedGoogle Scholar
  • 4 Pinheiro JM, Furdon S, Ochoa LF. Role of local anesthesia during lumbar puncture in neonates. Pediatrics 1993; 91 (02) 379-382
    CrossrefPubMedGoogle Scholar
  • 5 Juárez Gimenez JC, Oliveras M, Hidalgo E. et al. Anesthetic efficacy of eutectic prilocaine-lidocaine cream in pediatric oncology patients undergoing lumbar puncture. Ann Pharmacother 1996; 30 (11) 1235-1237
    CrossrefPubMedGoogle Scholar
  • 6 Holdsworth MT, Raisch DW, Winter SS, Chavez CM, Leasure MM, Duncan MH. Differences among raters evaluating the success of EMLA cream in alleviating procedure-related pain in children with cancer. Pharmacotherapy 1997; 17 (05) 1017-1022
    CrossrefPubMedGoogle Scholar
  • 7 Wong DL, Baker CM. Pain in children: comparison of assessment scales. Pediatr Nurs 1988; 14 (01) 9-17
    PubMedGoogle Scholar
  • 8 Tadicherla S, Berman B. Percutaneous dermal drug delivery for local pain control. Ther Clin Risk Manag 2006; 2 (01) 99-113
    PubMedGoogle Scholar
  • 9 Cruickshank A, Qeadan F, Kuttesch JF, Agarwal HS. Eutectic mixture of lidocaine and prilocaine versus 1% lidocaine injection for lumbar punctures in pediatric oncology patients. Pediatr Blood Cancer 2019; 66 (11) e27957
    CrossrefPubMedGoogle Scholar
  • 10 Nigrovic LE, Kuppermann N, Neuman MI. Risk factors for traumatic or unsuccessful lumbar punctures in children. Ann Emerg Med 2007; 49 (06) 762-771
    CrossrefPubMedGoogle Scholar