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EMLA cream

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EMLA cream, Eutectic Mixture of Local Anesthetic

  • See Also
  1. Local Skin Anesthesia
  2. Digital Block
  3. Lidocaine Local Skin Anesthesia (Xylocaine)
  4. Lidocaine-Epinephrine-Tetracaine (LET Anesthesia)
  • Indications
  1. Venipuncture
  2. Used prior to Local Anesthesia injection
  • Preparation
  • Ingredients
  1. Lidocaine 25 mg/ml
  2. Prilocaine 25 mg/ml
  3. Thickener, emulsifier, distilled water
  4. Buffered to pH of 9.4
  • Technique
  1. Apply thick layer to skin surface
    1. Apply 1-2 grams per 10 cm^2
    2. Maximum dose 10 grams
  2. Cream applied to Epidermis
  3. Occlusive Dressing applied (Tegaderm, Opsite)
  4. Held in place for 60-90 minutes
    1. Apply for only 5-30 minutes if over diseased skin
  5. Duration of Anesthesia: 30-120 minutes
  6. Depth of penetration
    1. Applied for 60 minutes: 3 mm depth
    2. Applied for 90-120 minutes: 5 mm depth
  • Advantages
  1. Minimal systemic absorption
  2. No skin distortion
  • Contraindications
  1. Age under 1 month old
  2. Methemoglobinemia
  3. Not FDA approved for open skin or mucous membranes
    1. Has however been used in Laceration Repair
    2. Zempsky (1997) Ann Emerg Med 30:163-6 [PubMed]
  • Efficacy
  1. Not effective for pain reduction before venipuncture in infants <3 months
    1. Shahid (2019) Pediatrics 143(1) +PMID:30587535
  • References
  1. Pfenninger (1994) Procedures, Mosby, p. 135-155
  2. Kundu (2002) Am Fam Physician 66(1):99-102 [PubMed]