title: Rapid onset of cutaneous anesthesia with EMLA cream after pretreatment with a new ultrasound-emitting device.
abstract: In this randomized, double-blinded, placebo-controlled, crossover trial of 42 human subjects, we examined the speed of onset of cutaneous anesthesia by eutectic mixture of local anesthetics (EMLA) cream after brief (approximately 10-s) pretreatment of the underlying skin with low-frequency (55 kHz) ultrasound. Four treatments were compared: ultrasound pretreatment followed by application of 1 g EMLA or placebo cream for 5 min, 10 min, 15 min, and 60 min without ultrasound pretreatment as positive control. Pain was tested by pricks with a 20 g needle. Pain scores and patient preference for EMLA or placebo cream were measured at each time point. Based on both pain scores and patient preference, cutaneous anesthesia was achieved in the EMLA groups as compared with placebo at all time points. After ultrasound pretreatment and then 5, 10, or 15 min after EMLA cream application, pain scores and overall preference were statistically indistinguishable from EMLA cream application for 60 min (without ultrasound pretreatment). There were no significant adverse effects. Low-frequency ultrasound pretreatment appears to be safe and effective in producing rapid onset of EMLA cream in this model, with results as early as 5 min.
  
  
  CONCLUSIONS
  A prospective, randomized, double-blinded, placebo-controlled clinical trial demonstrated rapid onset of cutaneous anesthesia by pretreatment of the skin with ultrasound before application of EMLA cream.
authors.affiliation: From the Pain Trials Center, Brigham & Women's Hospital, Boston, Massachusetts.
authors.forename: Nathaniel P
authors.initials: NP
authors.lastname: Katz
authors.forename: David E
authors.initials: DE
authors.lastname: Shapiro
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Herrmann
authors.forename: Joseph
authors.initials: J
authors.lastname: Kost
authors.forename: Linda M
authors.initials: LM
authors.lastname: Custer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000772:Anesthesia, Local / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D000077442:Lidocaine, Prilocaine Drug Combination; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000187:drug effects; D011318:Prilocaine / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D012727:Sex Characteristics; D012867:Skin / Q000187:drug effects* / Q000528:radiation effects*; D012880:Skin Pigmentation / Q000502:physiology; D014465:Ultrasonics
chemical_list: D000779:Anesthetics, Local; D000077442:Lidocaine, Prilocaine Drug Combination; D011318:Prilocaine; D008012:Lidocaine