DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20214151

Efficacy of eutectic mixture of local anesthetics in alleviating pain associated with lumbar puncture in newborns: a placebo compared randomized controlled trial

Akshi Sharma, Rakesh Sharma, Mangla Sood, Pancham Kumar

Abstract


Background: Lumbar puncture (LP) is one of the most commonly encountered painful procedure in paediatric medicine. Research has shown that neonates too experience pain from noxious stimuli that can be more intense than what is experienced by an adult, and so have the right to receive safe, efficient and effective pain management. Objective was to determine efficacy of topical eutectic mixture of local anesthetics (EMLA) in alleviating pain associated with lumbar puncture among newborns admitted to sick newborn care unit (SNCU).

Methods: The study was a one-year tertiary care teaching hospital-based randomised comparative double blinded trial among 42 neonates aged 32 weeks or more admitted to SNCU and required a diagnostic lumbar puncture, randomly assigned to one of two groups. Half hour before the procedure, 1 g of topical EMLA cream was applied to LP site in intervention group versus placebo in other group. At different stages, the heart rate, transcutaneous oxygen saturation level, and total behaviour score were captured on a video camera and rated using the neonatal facial coding system.

Results: EMLA dramatically lowers pain sensitivity when compared to placebo. Total behavioural score means±standard deviation (SD) at the moment of needle insertion (EMLA: 1.05±1.24; placebo: 2.71±1.76, p≤0.001) and post procedural 5 minute later was (EMLA: 0.05±0.22; placebo: 0.81±0.92, p≤0.01). Similarly, oxygen saturation level when needle was in spinal place (EMLA: 96.76±2.45; placebo: 94.29±3.62, p=0.01) and post procedural 1 hour later was (EMLA: 98.81±1.94; placebo: 97.48±2.18, p=0.04). The heart rate of all newborns in both groups was greater than it was at baseline, although the difference was not significant.

Conclusions: EMLA is an effective agent in reducing pain associated with LP among newborns.


Keywords


Infant, Newborn, Lumbar puncture, Lidocaine, Prilocaine drug combination, Pain management

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References


Anand KJS, Hickey PR. Pain and Its Effects in the Human Neonate and Fetus. N Engl J Med. 1987;317(21):1321-9.

M Holsti L, Grunau RE, Shany E. Assessing pain in preterm infants in the neonatal intensive care unit: moving to a 'brain-oriented' approach. Pain Manag. 2011;1(2):171-9.

Hui-Chen F, Hsiu-Lin C, Shun-Line C. The Effect of EMLA Cream on Minimizing Pain during Venipuncture in Premature Infants. J Trop Pediatr. 2013;59(1):72-3.

Sharara-Chami R, Lakissian Z, Charafeddine L, Milad N, El-Hout Y. Combination Analgesia for Neonatal Circumcision: A Randomized Controlled Trial. Pediatrics. 2017;140(6):e20171935.

Spence K, Henderson-Smart D, New K, Evans C, Whitelaw J, Woolnough R. Evidenced-based clinical practice guideline for management of newborn pain. J Paediatr Child Health. 2010;46(4):184-92.

Prechtl HFR. The behavioural states of the newborn infant (a review). Brain Res. 1974;76(2):185-212.

Garcia OC, Reichberg S, Brion LP, Schulman M. Topical anesthesia for line insertion in very low birth weight infants. J Perinatol. 1997;17(6):477-80.

Grunau RVE, Craig KD. Pain expression in neonates: facial action and cry. Pain. 1987;28(3):395-410.

Centers for Disease Control and Prevention. Epi InfoTM. Available at: https://www.cdc.gov/epiinfo/ index.html. Accessed on 08 October 2021.

Kaur G, Gupta P, Kumar A. A Randomized Trial of Eutectic Mixture of Local Anesthetics During Lumbar Puncture in Newborns. Arch Pediatr Adolesc Med. 2003;157(11):1065.

Tran AN, Koo JY. Risk of systemic toxicity with topical lidocaine/prilocaine: a review. J Drugs Dermatol. 2014;13(9):1118-22.