A clinical study to evaluate the efficacy of ELA-Max (4% liposomal lidocaine) as compared with eutectic mixture of local anesthetics cream for pain reduction of venipuncture in children.
OBJECTIVE
A double-randomized, blinded crossover trial was performed to assess the efficacy of ELA-Max (4% liposomal lidocaine) as compared with eutectic mixture of local anesthetics (EMLA) for pain relief during pediatric venipuncture procedures. Safety was assessed by evaluation for topical or systemic effects and measurement of serum lidocaine concentrations.


METHODS
A total of 120 children who were scheduled for repeat venipuncture for non-study-related reasons at 2 sites participated in the study. Patients were doubly randomized to treatment regimen (study medication application time of either 30 or 60 minutes) and to the order of application of the topical anesthetics for each venipuncture. The primary outcome measures were the child's rating of pain immediately after the venipuncture procedures using a 100-mm visual analog scale (VAS) tool and the parent's and blinded research observer's Observed Behavioral Distress scores.


RESULTS
Both ELA-Max and EMLA seemed to alleviate venipuncture pain. There was no clinically or statistically significant difference in the patient VAS scores within the 30-minute or 60-minute treatment groups, and there was no clinical or statistical difference in VAS scores between the 30-minute ELA-Max treatment without occlusion and the 60-minute EMLA treatment with occlusion. There were no clinically or statistically significant differences between treatment with ELA-Max and EMLA in parental or blinded researcher Observed Behavioral Distress scores, the most frequent response at any observation time being "no distress."


CONCLUSIONS
This study demonstrates that a 30-minute application of ELA-Max without occlusion is as safe and as effective for ameliorating pain associated with venipuncture as a 60-minute application of the prescription product EMLA requiring occlusion.
Eichenfield
Lawrence F
LF
Division of Pediatric and Adolescent Dermatology, Children's Hospital, San Diego, California, USA. leichenfield@ucsd.edu
Funk
Ann
A
Fallon-Friedlander
Sheila
S
Cunningham
Bari B
BB
D000293:Adolescent; D019162:Anesthetics, Combined / Q000008:administration & dosage / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004655:Emulsions / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use*; D000077442:Lidocaine, Prilocaine Drug Combination; D008081:Liposomes; D008297:Male; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement / Q000379:methods; D018962:Phlebotomy / Q000009:adverse effects / Q000379:methods*; D011318:Prilocaine / Q000627:therapeutic use*; D016896:Treatment Outcome
D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D004655:Emulsions; D000077442:Lidocaine, Prilocaine Drug Combination; D008081:Liposomes; D011318:Prilocaine; D008012:Lidocaine