title: Cutaneous tape stripping to accelerate the anesthetic effects of EMLA cream: a randomized, controlled trial.
abstract: Most medications are not absorbed topically due to the stratum corneum barrier. While effective as a topical anesthetic, EMLA cream is absorbed slowly, delaying its effects for up to one hour, thereby limiting its usefulness.
  
  
  OBJECTIVE
  To determine whether removal of the cornified layer of the skin by tape stripping (TS) would allow more rapid onset of anesthesia after topical application of EMLA cream prior to IV catheterization (IVC).
  
  
  METHODS
  This was a prospective, randomized, controlled trial comparing the levels of pain of IVC 15 minutes after topical application of EMLA cream in patients who had TS vs patients who did not. The setting was a suburban university-affiliated ED. A convenience sample of 68 alert adult patients requiring IVC were enrolled. The primary outcomes measured were pain of IVC and pain of TS using a previously validated 100-mm visual analog scale as well as the IVC success rate.
  
  
  RESULTS
  The pain of IVC was less for TS vs control patients [29.7 mm (95% CI=20.4 to 39.0 mm) vs 15.9 mm (95% CI=9.1 to 22.6 mm), p=0.017]. The mean pain of TS was 4.8+/-7.4 mm. The IVC success rate for TS vs control patients was 91% vs 74% (p=0.056). There were no adverse events after TS.
  
  
  CONCLUSIONS
  Removal of the cornified layer of the skin resulted in a more rapid anesthetic effect of EMLA cream as evidenced by lower IVC pain scores after TS. The effectiveness of TS for enhanced absorption of other medications should be investigated.
authors.affiliation: Department of Emergency Medicine, State University of New York at Stony Brook, USA. asinger@epo.som.sunysb.edu
authors.forename: A J
authors.initials: AJ
authors.lastname: Singer
authors.forename: J
authors.initials: J
authors.lastname: Shallat
authors.forename: S M
authors.initials: SM
authors.lastname: Valentine
authors.forename: L
authors.initials: L
authors.lastname: Doyle
authors.forename: V
authors.initials: V
authors.lastname: Sayage
authors.forename: H C
authors.initials: HC
authors.lastname: Thode
mesh_terms: D000328:Adult; D019162:Anesthetics, Combined / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002406:Catheterization, Peripheral; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D000077442:Lidocaine, Prilocaine Drug Combination; D008297:Male; D008875:Middle Aged; D009824:Ointments / Q000008:administration & dosage*; D010146:Pain / Q000517:prevention & control; D011318:Prilocaine / Q000008:administration & dosage*; D012867:Skin
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D000077442:Lidocaine, Prilocaine Drug Combination; D009824:Ointments; D011318:Prilocaine; D008012:Lidocaine