Varghese Kathryn S, Ahmed Adham, Mathew Dave M, Fusco Peter J, Abraham Mabel N
CUNY School of Medicine, New York, NY, USA.
The Feinstein Institutes for Medical Research, New Hyde Park, NY, USA.
Pediatr Res. 2024 Jul;96(1):51-56. doi: 10.1038/s41390-024-03113-7. Epub 2024 Mar 1.
Pediatric patients often receive topical anesthesia before skin procedures in the Emergency Department, with EMLA cream and amethocaine gel being common choices. The most effective option remains a subject of debate.
Our goal was to compare EMLA cream with amethocaine gel in pediatric patients undergoing topical anesthesia, focusing on outcomes: first-attempt cannulation success, child-reported visual analogue scale (VAS) score, parent-reported VAS score, observed pain score, child-reported absence of pain, and child-reported acceptable anesthesia.
A database search for studies comparing EMLA cream and amethocaine gel in pediatric topical anesthesia was conducted. Two reviewers extracted and cross-verified data, with a third ensuring accuracy. Using R software, a pairwise meta-analysis was performed via the Mantel-Haenszel method. Outcomes were pooled as risk ratios or standard mean differences with 95% confidence intervals using the random-effects model.
Amethocaine gel surpasses EMLA cream in child-reported pain absence and first cannulation success. No significant differences were found in child-reported acceptable anesthesia or observed pain scores. Similarly, child- and parent-reported VAS scores showed no variations between EMLA and amethocaine.
This analysis favors amethocaine gel for pediatric topical anesthesia. Further large randomized trials comparing EMLA cream and amethocaine gel in pediatric patients are warranted.
Procedural pain is a major concern for pediatric patients, their families, and physicians. Topical anesthesia is routinely given prior to children undergoing skin-related procedures in the Emergency Department. In pediatric patients, topical anesthetics such as eutectic mixture of local anesthetics cream and amethocaine gel have proved to be pioneering in pain reduction, but the most effective method is often disputed. Presently, this is the most comprehensive pooled analysis of trials comparing EMLA cream and amethocaine gel in pediatric patients undergoing topical anesthesia. Amethocaine performed better with regards to child-reported absence of pain and first attempt cannulation success.
儿科患者在急诊科进行皮肤操作前常接受局部麻醉，复方利多卡因乳膏和阿美卡因凝胶是常用选择。最有效的选择仍是一个有争议的话题。
我们的目标是比较复方利多卡因乳膏和阿美卡因凝胶在接受局部麻醉的儿科患者中的效果，重点关注以下结果：首次插管成功率、儿童报告的视觉模拟评分（VAS）、家长报告的VAS评分、观察到的疼痛评分、儿童报告的无痛情况以及儿童报告的可接受麻醉情况。
对比较复方利多卡因乳膏和阿美卡因凝胶在儿科局部麻醉中应用的研究进行数据库检索。两名评审员提取并交叉验证数据，第三名评审员确保数据准确性。使用R软件，通过Mantel-Haenszel方法进行成对荟萃分析。使用随机效应模型将结果汇总为风险比或标准化平均差，并给出95%置信区间。
在儿童报告的无痛情况和首次插管成功率方面，阿美卡因凝胶优于复方利多卡因乳膏。在儿童报告的可接受麻醉情况或观察到的疼痛评分方面未发现显著差异。同样，儿童和家长报告的VAS评分在复方利多卡因和阿美卡因之间也没有差异。
该分析支持阿美卡因凝胶用于儿科局部麻醉。有必要进一步开展大型随机试验，比较复方利多卡因乳膏和阿美卡因凝胶在儿科患者中的应用。
操作疼痛是儿科患者、其家属和医生主要关注的问题。在急诊科，儿童进行与皮肤相关的操作前通常会进行局部麻醉。在儿科患者中，局部麻醉剂如复方利多卡因乳膏和阿美卡因凝胶已被证明在减轻疼痛方面具有开创性，但最有效的方法往往存在争议。目前，这是对比较复方利多卡因乳膏和阿美卡因凝胶在接受局部麻醉的儿科患者中应用的试验进行的最全面的汇总分析。在儿童报告的无痛情况和首次尝试插管成功率方面，阿美卡因表现更好。
