To evaluate the role of a new formulation of lidocaine (ELA-max) in local anesthesia in children and compare it with the eutectic mixture of local anesthetics (EMLA).
DATA SOURCES
Relevant literature was identified by a MEDLINE search (1966—November 2003) using the search terms ELA-max and EMLA. Bibliographies of selected articles were also examined to include all relevant investigations. The product manufacturer was contacted for inclusion of the most recent data available.
DATA SYNTHESIS
Topical anesthesia in children is clinically challenging. ELA-max has been shown to be as effective as EMLA for venipuncture in children, but with faster onset. Adverse effects, such as transient blanching with redness and erythema, have been reported.
CONCLUSIONS
Further investigation is needed to determine the effectiveness of ELA-max on other painful procedures in children, as well as its safety.
. DesboroughJP. The stress response to trauma and surgery. Br J Anaesth2000; 85: 109–17.
2.
. AnandKJ, CarrDB. The neuroanatomy, neurophysiology, and neurochemistry of pain, stress, and analgesia in newborns and children. Pediatr Clin North Am1989; 36: 795–822.
3.
. TaddioA, OhlssonK, OhlssonA. Lidocaine—prilocaine cream for analgesia during circumcision in newborn boys. Cochrane Database Syst Rev2000;(2):CD000496.
4.
. CordoniA, CordoniLE. Eutectic mixture of local anesthetics reduces pain during intravenous catheter insertion in the pediatric patient. Clin J Pain2001; 17: 115–8.
5.
. KohJL, FanurikD, StonerPD, SchmitzML, VonLanthenM. Efficacy of parental application of eutectic mixture of local anesthetics for intravenous insertion. Pediatrics1999; 103: e79.
6.
. SharmaBB, JainSK, VyasSP. Topical liposome system bearing local anesthetic lidocaine. Preparation and evaluation. J Microencapsul1994; 11: 279–86.
7.
. BucaloBD, MirikitaniEJ, MoyRL. Comparison of skin anesthetic effect of liposomal lidocaine, non-liposomal lidocaine, and EMLA using 30-minute application time. Dermatol Surg1998; 24: 537–41.
8.
. FoldvariM, GesztesA, MezeiM. Dermal drug delivery by liposome encapsulation: clinical and electron microscopic studies. J Microencapsul1990; 7: 479–89.
9.
. MezeiM. Liposomes as penetration promoters and localizers of topically applied drugs. In: HsiehDS, ed. Drug permeation enhancement. New York: Marcel Dekker, 1993: 171–98.
. KunduS. Principles of office anesthesia. Part II: topical anesthesia. Am Fam Physician2002; 66: 99–102.
12.
. FoldvariM. In vitro cutaneous and percutaneous delivery and in vivo efficacy of tetracaine from liposomal and conventional vehicles. Pharm Res1994; 11: 1593–8.
13.
. FriedmanPM, FogelmanJP, NouriK, LevineVJ, AshinoffR. Comparative study of the efficacy of four topical anesthetics. Dermatol Surg1999; 25: 950–4.
14.
. HuangW. Topical anesthetics in dermatology. J Am Acad Dermatol2000; 43: 286–98.
15.
. AltmanDA, GildenbergSR. High-energy pulsed light source hair removal device used to evaluate the onset of action of a new topical anesthetic. Dermatol Surg1999; 25: 816–8.
16.
. JenkinsAV. Acute convulsive reaction to surface anesthetic: treatment by depolarizing muscle relaxant. Br J Anaesth1962; 34: 61–4.
17.
. KoppelRA, ColemanKM, ColemanWP. The efficacy of EMLA versus ELA-Max for pain relief in medium-depth chemical peeling: a clinical and histopathologic evaluation. Dermatol Surg2000; 26: 61–4.
18.
. EichenfieldLF, FunkA, Fallon-FriedlanderS, CunninghamBB. A clinical study to evaluate the efficacy of ELA-max (4% liposomal lidocaine) as compared with eutectic mixture of local anesthetics cream for pain reduction of venipuncture in children. Pediatrics2002; 109: 1093–9.
19.
. KleiberC, SorensonM, WhitesideK, GronstalBA, TannousR. Topical anesthetics for intravenous insertion in children: a randomized equivalency study. Pediatrics2002; 110: 758–61.
20.
. FreyB, KehrerB. Toxic methaemoglobin concentrations in premature infants after application of a prilocaine-containing cream and peridural prilocaine. Eur J Pediatr1999; 158: 785–8.
. KennedyRM, LuhmannJD. The “ouchless emergency department.” Getting closer: advances in decreasing distress during painful procedures in the emergency department. Pediatr Clin North Am1999; 46: 1215–47.
