Emla versus ice as a topical anesthetic.
BACKGROUND
There are many different topical anesthetics available. Ice is an easy to use and inexpensive topical anesthetic. There are studies comparing different topical anesthetics but none have used ice.


OBJECTIVE
To evaluate the efficacy between EMLA (2.5% lidocaine and 2.5% prilocaine cream) and ice prior to injection with a 30-gauge needle containing a painful stimuli.


METHODS
A fingertip amount of EMLA cream was placed on the upper left arm and occluded with a bandage for an average of 52 minutes. Ice in a rubber glove was placed on the right upper arm for 1-2 minutes. The EMLA site, ice site, and a control site without anesthetic were tested for cutaneous analgesia with an injection of 1% lidocaine with 1:100,000 epinephrine through a 30-gauge needle using a 3 cc syringe. Discomfort was recorded using a visual acuity scale (VAS). Analysis of data was performed using a t test paired sample of two means.


RESULTS
Statistically there was a significant difference in pain control between EMLA and ice (P <.05), EMLA and control (P <.01), and ice and control (P <.01). Clinically patients felt that EMLA performed slightly better as an analgesic than ice, and both EMLA and ice were more efficacious than the control.


CONCLUSIONS
Both EMLA and ice decreased the discomfort associated with needle injection. Although EMLA performed better in pain control, ice has advantages in ease of use, fast action, and is less expensive than EMLA. Both EMLA and ice were good topical anesthetics, each with advantages and disadvantages in clinical use.
Kuwahara
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RT
University of Tennessee, Division of Dermatology, Memphis, Tennessee, USA. r.kuwahara@excite.com
Skinner
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RB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local; D005260:Female; D006801:Humans; D007053:Ice; D007267:Injections / Q000009:adverse effects*; D008012:Lidocaine; D000077442:Lidocaine, Prilocaine Drug Combination; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011318:Prilocaine
D000779:Anesthetics, Local; D007053:Ice; D000077442:Lidocaine, Prilocaine Drug Combination; D011318:Prilocaine; D008012:Lidocaine