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Evaluation of Eutectic Lidocaine/Prilocaine Cream (EMLA®) for Steroid Joint Injection in Children with Juvenile Rheumatoid Arthritis: A Double Blind, Randomized, Placebo Controlled Trial
YOSEF UZIEL, MATITIAHU BERKOVITCH, MADLEN GAZARIAN, GIDEON KOREN, EARL D. SILVERMAN, RAYFEL SCHNEIDER, and RONALD M. LAXER
ABSTRACT. Methods. A randomized, double blind, placebo controlled parallel group trial. Thirty-one children (ages 8-18 yrs) scheduled for steroid injection into a knee were randomized into groups having either 2.5 g lidocaine/prilocaine cream or placebo cream applied to the injection site 60-90 min before the procedure. Patients assessed the pain associated with initial needle insertion and subsequent steroid injection using a 10 cm visual analog scale. Results. No significant difference was found in the pain reported after needle insertion or steroid injection between the lidocaine/prilocaine cream group (n = 17) and the placebo group (n = 14). There was a trend toward an association of lower median scores with the pain of steroid injection in the lidocaine/prilocaine group (6 mm) compared with the placebo group (22 mm). Conclusion. Application of 2.5 g lidocaine/prilocaine cream for 60-90 min had no statistically significant analgesic effect on pain associated with injections of steroids into the knees of children with juvenile arthritis. (J Rheumatol 2003;30:594-6) Key Indexing Terms:
EMLA®
From the Divisions of Rheumatology and Clinical Pharmacology and Toxicology, Departments of Paediatrics, Immunology, and Medicine, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada. Supported in part by Astra Pharma Inc., Canada. Y. Uziel, MD, MSc, Fellow, Division of Rheumatology, Department of Pediatrics, University of Toronto and the Hospital for Sick Children (current position: Deputy Head, Department of Pediatrics, Sapir Medical Center, Kfar Saba, Tel Aviv University, Tel Aviv, Israel; M. Berkovitch, MD, Fellow, Division of Clinical Pharmacology, Department of Pediatrics, University of Toronto and the Hospital for Sick Children (current position: Head, Division of Clinical Pharmacology, Assaf Harofeh Hospital, Zerifin, Israel); M. Gazarian, MBBS, MSc, Fellow, Division of Rheumatology and Clinical Pharmacology, Department of Pediatrics, University of Toronto and the Hospital for Sick Children (current position: Senior Lecturer, School of Women's and Children's Health, University of New South Wales and Sydney Children's Hospital, Randwick, NSW, Australia; G. Koren, MD, Professor of Pediatrics, Pharmacy and Clinical Pharmacology, Department of Pediatrics; E.D. Silverman, MD, Professor of Paediatrics and Immunology; R. Schneider, MBBS, Associate Professor of Paediatrics; R.M. Laxer, MD, Professor of Paediatrics and Medicine, University of Toronto and the Hospital for Sick Children. Address reprint requests to Dr. R.M. Laxer, Division of Rheumatology, Room 8253, The Hospital For Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8. E-mail ronald.laxer@sickkids.ca Submitted May 30, 2002; revision accepted September 11, 2002. |