CC BY-NC 4.0 · Arch Plast Surg 2015; 42(01): 28-33
DOI: 10.5999/aps.2015.42.1.28
Original Article

Topical EMLA Cream as a Pretreatment for Facial Lacerations

Sung Woo Park
Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
,
Tae Suk Oh
Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
,
Jong Woo Choi
Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
,
Jin Sup Eom
Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
,
Joon Pio Hong
Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
,
Kyung S Koh
Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
,
Taik Jong Lee
Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
,
Eun Key Kim
Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
› Author Affiliations

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 ≥16 years 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.

This clinical trial was preformed according to Clinical Performance Improvement (CPI) guidelines of Asan Medical Center. This study was cooperatively performed by the Plastic Surgery and Emergency Departments.




Publication History

Received: 10 June 2014

Accepted: 14 August 2014

Article published online:
05 May 2022

© 2015. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Hollander JE, Singer AJ. Laceration management. Ann Emerg Med 1999; 34: 356-367
  • 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: 751-756
  • 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
  • 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: 812-815
  • 5 Singer AJ, Stark MJ. LET versus EMLA for pretreating lacerations: a randomized trial. Acad Emerg Med 2001; 8: 223-230
  • 6 Young KD. What's new in topical anesthesia. Clin Pediatr Emerg Med 2007; 8: 232-239
  • 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-E634
  • 8 Hahn IH, Hoffman RS, Nelson LS. EMLA-induced methemoglobinemia and systemic topical anesthetic toxicity. J Emerg Med 2004; 26: 85-88
  • 9 Brent AS. The management of pain in the emergency department. Pediatr Clin North Am 2000; 47: 651-679
  • 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: 503-505
  • 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: 81-83
  • 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: 231-233
  • 13 Zempsky WT, Karasic RB. EMLA versus TAC for topical anesthesia of extremity wounds in children. Ann Emerg Med 1997; 30: 163-166