A comparison between EMLA cream application versus lidocaine infiltration for postoperative analgesia after inguinal herniotomy in children.
BACKGROUND
EMLA cream (eutectic mixture of local anesthetics) has been shown to penetrate intact skin and provide analgesia of superficial layers. There are no studies on the effects of topical application of EMLA cream for postoperative pain relief after inguinal hernia repair.


OBJECTIVE
: This randomized, double-blind, placebo-controlled study compared the efficacy of topical application of 5% EMLA cream before surgery, with wound infiltration with 1% lidocaine for postoperative analgesia in children.


METHODS
Ninety children, aged 4 to 12 years, undergoing elective inguinal hernia repair under general anesthesia were enrolled in the study. Patients were randomly assigned to receive either placebo cream (group1), 5% EMLA cream (group 2), or placebo cream followed by 0.5 mL/kg 1% lidocaine (group 3) in the wound after induction of anesthesia. The anesthetic technique and monitoring were standardized, and postoperative pain was assessed using a 10-point objective pain scale. Fentanyl was used as rescue analgesic in immediate postoperative period, and acetaminophen was administered for postoperative pain in surgical ward.


RESULTS
The number of patients requiring fentanyl in the immediate postoperative period was significantly less in the study groups compared with the placebo group. Sixty-seven percent of patients in the placebo group required more than 1 dose of acetaminophen in the first 6 hrs compared with 23% (EMLA group) and 20% (lidocaine group). Four patients (two in the lidocaine group, one in the EMLA group, and one in the control group) developed subcutaneous infection at the site of incision 10 to 15 days postoperatively.


CONCLUSIONS
Topical application of EMLA (5%) provides postoperative analgesia comparable to infiltration with 1% lidocaine after inguinal hernia repair in children.
Usmani
Hammad
H
Department of Anesthesia, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India.
Pal Singh
Sarvesh
S
Quadir
Abdul
A
Chana
R S
RS
D000287:Administration, Topical; D000768:Anesthesia, General; D019162:Anesthetics, Combined / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D000077442:Lidocaine, Prilocaine Drug Combination; D008297:Male; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control*; D010919:Placebos; D011318:Prilocaine / Q000008:administration & dosage*; D011446:Prospective Studies
D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D000077442:Lidocaine, Prilocaine Drug Combination; D010919:Placebos; D011318:Prilocaine; D008012:Lidocaine