DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20211085

Comparison of efficacy of eutectic mixture of local anaesthetic with amethocaine on pain during venipuncture among term neonates in a tertiary care hospital, India

Anagha M. Nair, Vetriselvi Prabakaran, Adhisivam Bethou

Abstract


Background: Neonates are frequently subjected to painful procedures which can adversely affect future pain perception. Pain control measures during invasive procedures include non-pharmacological and pharmacological methods. One pharmacological intervention that can be used prior to a needle insertion procedure is application of a topical local anaesthetic to numb the skin. Topical anaesthetics prevent nerve impulse transmission, promoting skin analgesia by acting on the free dermal terminations. This study compares the efficacy of eutectic mixture of local anaesthetic with amethocaine on pain during venipuncture among term neonates.  

Methods: A randomized clinical trial was conducted with 70 term neonates who underwent venepuncture in neonatal intensive care unit of a   tertiary care centre.  A simple random sampling technique was used to enrol the neonates who met the inclusion criteria. Neonatal infant pain scale was used to collect the data. Descriptive and inferential statistics were used to analyse the data.  frequency and percentage were used to describe the clinical and demographic variables of the study participants. The efficacy of topical local anaesthetics was analysed using independent student t test. Chi-square test was used to identify the association of level of pain with clinical and demographic characteristics of the neonate.  The analysis was done with SPSS 21st version.

Results: Compared to amethocaine group, in eutectic mixture of local anaesthetic (EMLA) group only lesser number of neonates experienced severe level of pain and mild to moderate level of pain. Though mean pain score in EMLA group (3.457±1.633) was lesser than amethocaine group (4.000±1.514) it was not significant (p=0.347).

Conclusions: The study revealed the efficacy of topical anaesthetics in relieving pain in term neonates during venipuncture.


Keywords


Venipuncture, Term neonates, EMLA, Amethocaine, Pain

Full Text:

PDF

References


Grunau R, Holsti L. Long term consequences of pain in human neonates. Semin fetal neonatal med. 2006;11:268-75.

Merskey H, Albe DG, Bonica JJ. Pain terms:a list with definitions and notes on usage. J Pain. 1979;6:249-52.

Hockenberry MJ, Wilson D. Wong’s essentials of pediatric nursing, 8th ed. New York, Mosby. 2011;607-29.

Anna T, Joel K. The effects of early pain experiences in neonates on pain responses in infancy and childhood. Pediatric Drugs. 2005;7:245-57.

Gayle GP. Are there long-term consequences of pain in newborn or very young infants? J Perinatal Edu. 2004;13:10-7.

Brummelte TS, Gurunav RE, Chau V. Procedural pain and brain development in premature newborn. Ann Neurol. 2012;7:385-96.

John CP, Eichenwald, Hansen AR. Manual of Neonatal care.7th ed. Lippincott William and Wilkins. 2012.

Krishnan L. Pain relief in neonates. J Neonatal Surg. 2013;2:19-20.

Erin K, Woolfson J, McCafferty D. Percutaneous Local Anaesthesia. 3rd ed. Ellis Horwood Limited. 1993.

Carbajal R, Erickson M. Sedation and analgesia practices in neonatal intensive care units result from a prospective cohort study. Lancet Respir Med. 2015;3:796-812.

Evers H, Juhlin L, Vinnars E. Dermal effect of compositions based on EMLA. Br J Anaesth. 1985;57:997-1005.

Hallen B, Melvin H. A clinical study of a EMLA cream to reduce pain of venepuncture. Br J Anaesth. 1985;57:326-8.

Newbury C, Herd DW. Amethocaine versus EMLA for successful intravenous cannulation in children. Emerg Med J. 2009;26:487-91.

Lawrence J, Alcock D, Mcgranth P. The development of a tool to assess neonatal pain. Neonatal Netw. 1993;12:59-66.

Johnston CC, Strada ME. Acute pain response in infants: A multidimensional description. Pain.1986;24:373-82.

Anand KJ. Effects of perinatal pain and stress. Prog B rain Res. 2000;122:117-29.

Bouza H. The impact of pain in the immature brain. J Matern Fetal Neonatal Med. 2009;22:722-32.

Lawrence F, Eichenfield, Ann F, Sheide FF, Bari BC. A clinical study to evaluate the efficacy of ELA-Max (4% Liposomal Lidocaine) as compared with Eutectic mixture of Local anaesthetics cream for pain reduction of venipuncture in children. Pediatrics. 2002;109:1093-9.

Bishai R, Koren G. Relative efficacy of Amethocaine gel and lidocaine- prilocaine cream for port a cath puncture. Pediatrics. 1999;104:31-3.

Janet L, Sarah H, Mario S, Robert K. A comparison of buffered Lidocaine versus ELA-Max before peripheral intravenous catheter insertions in children. Pediatrics. 2004;113:217-20.