Eutectic mixture of lidocaine and prilocaine versus 1% lidocaine injection for lumbar punctures in pediatric oncology patients.
BACKGROUND
The role of local analgesics for lumbar punctures (LPs) in pediatric oncology patients has not been specifically studied.


AIM
To compare the efficacy of eutectic mixture of local anesthetics (EMLA) cream to 1% lidocaine injection for LPs.


METHOD
This was a retrospective observational study of all patients receiving either EMLA cream (EMLA group) or 1% lidocaine subcutaneous injection (lidocaine group) in addition to fentanyl and propofol for LPs over 18 months. Demographics, vital parameters, procedural and recovery times, propofol and fentanyl doses, and adverse events were studied.


RESULTS
Two hundred ninety LPs in 49 children were studied: 148 in the EMLA group and 142 in the lidocaine group. There was no difference in demographics or preprocedural parameters between the two groups. LPs in the EMLA group were completed in a shorter time (7.5 minutes [CI 7.0-8.1] vs 9.4 minutes [CI 8.9-9.9]) with a faster recovery time (38.7 minutes [CI 36.9-40.9] vs 43.9 minutes. [CI 41.9-45.9]) as compared with the lidocaine group (P < 0.001). The EMLA group required less maintenance doses (0.54 mg/kg [CI 0.47-0.62] vs 1.14 mg/kg [CI 1.06-1.21]) and total doses (2.58 mg/kg [CI 2.42-2.75] vs 3.12 mg/kg [CI 2.95-3.29]) of propofol as compared with the lidocaine group (P < 0.0001). Adverse events in the EMLA group were less (19% vs 41%) as compared with the lidocaine group (P < 0.0001).


CONCLUSION
The addition of EMLA cream for procedural sedation for LPs in pediatric oncology patients significantly improves pain management in comparison with 1% lidocaine injection.
['Cruickshank|Amy|A|0000-0002-2206-7519', 'Qeadan|Fares|F|', 'Kuttesch|John F|JF|', 'Agarwal|Hemant S|HS|0000-0002-3741-8481']
D000279:Administration, Cutaneous D000700:Analgesics D000779:Anesthetics, Local D002648:Child D005260:Female D005283:Fentanyl D006801:Humans D006993:Hypnotics and Sedatives D007275:Injections, Intravenous D007279:Injections, Subcutaneous D000077442:Lidocaine, Prilocaine Drug Combination D008297:Male D009824:Ointments D000073818:Pain, Procedural D015742:Propofol D013129:Spinal Puncture
lumbar puncture pediatric oncology local anesthetic EMLA cream procedural sedation