Clinical trial on the effectiveness of the application of lidocaine and prilocaine cream (EMLA) prior to lumbar puncture versus placebo to reduce pain in adults

Abstract Introduction Several studies provide evidence on the effectiveness of the application of EMLA cream in reducing pain in lumbar puncture in infants. However, as there are very few studies in adults, is quite scarce, it cannot be determined that its use is also effective in adults. Objective To determine if the application of the EMLA anaesthetic cream reduces the pain compared to the application of placebo when performing lumbar punctures in an adult population. Material and method A clinical trial was conducted with 22 patients using lidocaine-procaine cream (EMLA) versus placebo (moisturising cream). Eleven subjects were assigned to each group, randomising the first patient and alternately distributing the others into both groups. Results The median in level of pain of both groups 60 min before puncture, was 1 with an interquartile range of 2, according to a visual analogue scale (VAS). In both cases there was mild pain (less than 4). During puncture, both groups reported moderate pain (EMLA: 6.54 ± 2 vs. Placebo: 5.46 ± 2.09) p  = 0.464. One hour after the technique, both groups had a median in level of pain of 1, with an interquartile range of 2, p  = 0.317. No significant within or between group differences were detected in the level of pain or other variables, such as systolic blood pressure and heart rate, 1 hour before and during puncture. Conclusions There were no significant differences in the patients who were treated with EMLA and patients treated with placebo, compared to the studies reviewed previously. More studies need to be carried out with larger patient sample, and to take into account other variables, such as anxiety level, skin thickness, and time of exposure to the product.