Management of Acute Pain in Children: Pharmacologic

Local Anesthetics and Regional Anesthesia

Topical anesthetics
Until recently local anesthetics had to be injected into the skin to be effective. A number of new topical anesthetics have recently become widely available to provide pain relief prior to the many anticipated needle-stick procedures that children must undergo in the first 6 years of life.

Eutectic Mixture of Local Anesthetics

Eutectic mixtures of local anesthetics such as lidocaine/prilocaine and lidocaine/tetracaine are effective in reducing pain from dermatologic procedures, venipuncture, etc. The mixture of lidocaine/prilocaine (EMLA) was one of the first topical anesthetics commercially available for use on intact skin and has been the most extensively used and studied.^46,47 The physico/chemical feature of this type of mixture permits a higher effective concentration at the stratum corneum and increases the rate of uptake.

Clinical trials have shown effectiveness of EMLA in reducing the pain or distress of a number of common pediatric procedures including venous cannulation, venipuncture, lumbar puncture, circumcision, urethral meatotomy and adhesion release, immunizations, arterial cannulation, dermatologic procedures, allergy testing, accessing implanted central venous access catheters, and laceration repair. EMLA must be applied in a thick layer and is most effective if left undisturbed for at least 90 to 120 minutes.⁴⁸ Allowing time for the cream to be fully effective may be difficult in busy ambulatory clinics, so a new patch delivery system has been developed for EMLA and lidocaine/tetracaine (Synera) that simplifies the application process and makes it easier for parents to apply the cream at home prior to outpatient procedures.