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Report by Russell Boyd, Consultant Search checked by Michelle Jacobs, Specialist Registrar
Clinical scenario
A 5 year old child is to undergo venepuncture for a diagnostic blood test. You wonder if the application of Ametop (4% amethocaine gel) or EMLA (eutectic mixture of local anaesthetics (2.5% lignocaine (lidocaine) with 2.5% prilocaine)) will be better at reducing the pain of venepuncture.
Three part question
In [a 5 year old child] is [EMLA or amethocaine gel] better at [reducing the pain of venepunture].
Search strategy
Medline 1966–12/00 using the OVID interface. [(exp tetracaine OR tetracaine.mp OR amethocaine.mp) AND (exp prilocaine OR prilocaine.mp OR EMLA.mp OR exp lidocaine OR lidocaine.mp)]) AND (exp anaesthetics, combined OR exp aneasthetics, local}] LIMIT to human AND english.
Search outcome
Altogether 72 papers found of which 67 were irrelevant or of insufficient quality. The remaining five papers are shown in table 2.
Comments
The studies listed are of variable quality but the trend seems to favour Ametop as the superior anaesthetic. This product may also have advantages in terms of speed of onset and vasodilatation.
Clinical bottom line
Ametop is superior to EMLA for topical anaesthesia before venepuncture in children
Report by Russell Boyd, Consultant Search checked by Michelle Jacobs, Specialist Registrar