• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • 0 CME Hours
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
#Grand Rounds

Does EMLA Cream Reduce Pain in Infants Undergoing Venipuncture Compared to Breastfeeding?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • EMLA cream, widely used to prevent or reduce pain in infants undergoing venipuncture, is composed of lidocaine (25 mg/g) and prilocaine (25 mg/g) in a cream base
  • Evidence that it may be helpful but conflicting evidence in younger infants
    • In addition, both lidocaine and prilocaine can result in an increase in methemoglobin in infants, which has reduced oxygen binding capacity
  • Shahid et al. (Pediatrics, 2019) assessed the efficacy and safety of EMLA cream in infants <3 months requiring venipuncture

METHODS:

  • Meta-analysis of randomized controlled trials (RCTs) comparing EMLA with nonpharmacological interventions
  • Nonpharmacological comparators were
    • Placebo | No EMLA (no treatment at all) | Sucrose | Breastfeeding | Skin-to-skin care
  • Pain in infants was assessed using validated pain scales and measures
  • Methemoglobinemia: >5% methemoglobin
  • Primary outcomes
    • Pain reduction | Change in physiologic variables | Methemoglobinemia
  • Secondary outcomes
    • Total duration of crying | Heart rate and desaturation | Venipuncture attempts | Skin-blanching events (white or pale skin due to vasoconstriction)

RESULTS:

  • Ten randomized controlled trials were included, totaling 907 infants
  • Compared to sucrose, breastfeeding, and placebo, EMLA provided little or no effect on pain reduction
    • Standardized mean difference: 0.14 (95% CI, 0.17 to 0.45; 6 trials, n = 742; moderate-quality evidence)
  • Compared to placebo
    • EMLA revealed a small-to-moderate effect on increasing methemoglobin levels
    • Mean difference: 0.35 (95% CI: 0.04 to 0.66; 2 trials, n = 134; low-quality evidence)
  • EMLA group had an increased risk of blanching of the skin
    • Relative risk: 2.63 (95% CI: 1.58 to 4.38; 2 trials, n = 123; very low-quality evidence)

CONCLUSION:

  • EMLA provides minimal benefits while elevating methemoglobin levels and increasing risk of skin blanching
  • The authors found EMLA to be inferior to sucrose or breastfeeding for pain control
  • The authors suggest that EMLA should be avoided and nonpharmacologic interventions to reduce pain should be used instead in infants <3 months of age

Learn More – Primary Sources:

Efficacy and Safety of EMLA Cream for Pain Control Due to Venipuncture in Infants: A Meta-analysis.

Methemoglobinemia and Medications A to Z

Now You Can Get ObG Clinical Research Summaries Direct to Your Phone

Learn More  »

image_pdfFavoriteLoadingFavorite

< Previous
All #Grand Rounds Posts
Next >

Related ObG Topics:

FDA Restricts Codeine and Tramadol in Children and Breastfeeding Mothers – ACOG SMFM ABM Respond 
Does Breastfeeding During Vaccination Decrease Infant Pain?

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • #Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

ObG Library

  • Hysteroscopy
  • Fertility
  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Log In to ObG First

Please log in to access OBGFirst and the 2T Ultrasound Atlas

Password Trouble?

Sign Up for ObGFirst

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!

ObG First Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site