EMLA anaesthetic cream for sharp leg ulcer debridement: a review of the clinical evidence for analgesic efficacy and tolerability.

Sharp debridement is a fast method of achieving a clean leg ulcer, which promotes healing and enables skin grafting. EMLA cream is the only topical anaesthetic for which there is clinical evidence of analgesic efficacy for debridement. Thirteen clinical investigations of EMLA are reviewed. Four double-blind studies and one open randomised controlled study show that EMLA applied to the ulcer for 30-45 min under occlusion significantly reduces the pain from sharp debridement, decreases the incidence of post-debridement pain and reduces the time needed to achieve a clean ulcer, giving potential savings in healthcare costs. Doses of up to 10 g EMLA result in plasma levels of lidocaine and prilocaine well below toxic levels. Repeated treatment does not change the bacterial flora of the ulcer and rarely causes sensitisation. The treatment of pain in leg ulcer patients is important for patient satisfaction and for patient-perceived quality of life.