Use of EMLA cream for skin anaesthesia prior to epidural insertion in labour.

The efficacy of the use of EMLA cream to provide skin anaesthesia prior to the insertion of 16 G Tuohy needles was assessed. Sixty women in labour were randomly allocated to receive either EMLA cream over the proposed epidural site for a minimum period of 5 min (mean 9.1 min), a skin bleb and subcutaneous injection of lignocaine 2% (1 ml), or a skin bleb with additional lignocaine 2% (2 ml) infiltrated into the supra- and interspinous ligaments using a 23 G needle. Once the epidural catheter was sited, using a standard technique, 10 cm visual analogue pain scales were completed independently by the patient, by a blinded midwife and by the anaesthetist siting the epidural. Patients' perception of pain was not significantly different in any of the three groups, although the mean pain score was least in the group receiving full infiltration. The anaesthetists consistently underestimated the patients' perception of pain.