title: Use of a eutectic mixture of local anesthetics for prolonged subcutaneous drug administration.
abstract: The efficacy of a eutectic mixture of local anesthetics (EMLA) in alleviating the pain associated with subcutaneous needle insertion for infusion of the iron-chelating agent, deferoxamine, was examined in 12 patients with homozygous beta-thalassemia. As reported by the patient using a 100-mm visual analogue scale, the pain of insertion was rated as significantly less after application of EMLA (mean +/- SD, 1.5 +/- 2.2 mm) than the pain associated with needle insertion without EMLA (34.8 +/- 33.5 mm, P = .005). Subsequently, in a double-blind randomized trial of 10 beta-thalassemia patients, EMLA was significantly better (5.7 +/- 8.2 mm) than placebo (27.0 +/- 22.8 mm, P = .01) in reducing the pain of needle insertion for deferoxamine infusion. No adverse effects were reported with the use of EMLA cream. These results suggest that EMLA may be effective in reducing the pain associated with needle insertion for subcutaneous deferoxamine infusion in beta-thalassemia patients, which may lead to improved compliance with this irritating, prolonged therapy. The safety of EMLA use in these patients, and others receiving regular parenteral therapy, should now be examined.
authors.affiliation: Division of Clinical Pharmacology, Hospital for Sick Children, Toronto, Ontario.
authors.forename: M
authors.initials: M
authors.lastname: Berkovitch
authors.forename: S
authors.initials: S
authors.lastname: Davis
authors.forename: D
authors.initials: D
authors.lastname: Matsui
authors.forename: J
authors.initials: J
authors.lastname: Donsky
authors.forename: G
authors.initials: G
authors.lastname: Koren
authors.forename: N F
authors.initials: NF
authors.lastname: Olivieri
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage / Q000494:pharmacology*; D003676:Deferoxamine / Q000008:administration & dosage* / Q000627:therapeutic use; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous / Q000009:adverse effects; D008012:Lidocaine / Q000008:administration & dosage / Q000494:pharmacology*; D000077442:Lidocaine, Prilocaine Drug Combination; D008297:Male; D009824:Ointments; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement; D010865:Pilot Projects; D011318:Prilocaine / Q000008:administration & dosage / Q000494:pharmacology*; D013997:Time Factors; D017086:beta-Thalassemia / Q000188:drug therapy
chemical_list: D000779:Anesthetics, Local; D004338:Drug Combinations; D000077442:Lidocaine, Prilocaine Drug Combination; D009824:Ointments; D011318:Prilocaine; D008012:Lidocaine; D003676:Deferoxamine