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ESRA19-0208 Use of EMLA cream for skin anesthesia and epidural insertion in patients with cesarean section
  1. K Doi1,
  2. Y Ueda1,
  3. K Ugata1,
  4. H Kushizaki1 and
  5. N Imamachi2
  1. 1NHO Hamada Medical Center, Anesthesiology, Izumo City, Japan
  2. 2Shimane University Faculty of Medicine, Anesthesiology, Izumo City, Japan


Background and aims Pain relief of epidural anesthesia in cesarean section is difficult. EMLA, a eutectic mixture of lidocaine and prilocaine, is effective for pain reduction during venipuncture and superficial surgery. However, its effectiveness during epidural insertion is not well elucidated. The aim of this randomized, double blind study was to evaluate the efficacy of EMLA for epidural insertion in elective cesarean section.

Methods With Institutional Review Board approval and written patients’ informed consent, 40 ASA physical status 2 patients (aged 23 to 45) scheduled for elective cesarean section were included in this study. The parturients were randomized to applied ELMA (Group A) or placebo cream (Group B) about 1 hour prior to anesthesia. Pain during skin infiltration with 1% mepivacaine and subsequent insertion of Touhy needle was assessed immediately after each procedure. The presence of patient’s response with physical withdrawal on both procedures was recorded. Statistical analysis was performed using Mann-Whitney U test and Chi-squared test. A P value <0.05 was considered significant.

Results Median VAS values on skin infiltration and on insertion of Touhy needle did not differ between Group A and Group B. The incidence of patient’s response with physical withdrawal on skin infiltration was not different between groups. However, that on insertion of Touhy needle was significant lower in group A than in group B (Group A 0%, Group B 21%).

Conclusions EMLA cream could not reduce the pain during epidural insertion. However, EMLA plus 1% mepivacaine infiltration may optimize patients comfort for Touhy needle insertion.

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