Topical Anesthesia in Cutaneous Head and Neck Surgery: A Randomized Controlled Trial.
cutaneous malignancies
facial plastics
head and neck
Journal
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
ISSN: 1097-6817
Titre abrégé: Otolaryngol Head Neck Surg
Pays: England
ID NLM: 8508176
Informations de publication
Date de publication:
26 Oct 2024
26 Oct 2024
Historique:
revised:
04
09
2024
received:
18
06
2024
accepted:
15
10
2024
medline:
26
10
2024
pubmed:
26
10
2024
entrez:
26
10
2024
Statut:
aheadofprint
Résumé
Cutaneous head and neck surgery can safely and effectively be performed using local anesthetic (LA). However, optimizing pain management during LA administration is paramount for patient comfort and procedural efficacy. The primary objective of this study was to investigate the comparative effectiveness of EMLA cream and ethyl chloride (EC) spray in mitigating pain associated with LA administration in cutaneous head and neck surgery. Randomized controlled trial. University-affiliated tertiary head and neck oncology center. Sample size calculation was performed followed by computer randomization into the following groups: EMLA, EMLA placebo (aqueous cream), EC, and a control group (no topical agent). Demographics, pain, and procedural experience scores were recorded perioperatively. Statistical analysis was performed to analyse differences between groups utilizing the Mann-Whitney U test, Kruskall-Wallis test, Chi-square test, and Spearman's Rho. 121 cutaneous lesions with a median patient age of 76 were analyzed. There were no statistically significant differences in pain scores (median [IQR]) between patients receiving EMLA (4 [3.75]), EMLA placebo (4.8 [3.6]), EC (5.8 [2.8]), and no treatment (5 [4.1], P = .19). Procedural experience scores were clinically similar (P = .02). Risk factors associated with elevated nociceptive sensitivity were surgical site (scalp, P = .01), malignant lesions (P < .01) and lesion surface area (rs = 0.22, P = .01). EMLA and EC did not mitigate LA-associated pain in patients undergoing cutaneous head and neck surgery and as such practitioners should reconsider their use of these in this regard. Patients' operative experience remains excellent regardless of topical anesthetic use. Ib.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.
Références
Newlands C, Currie R, Memon A, Whitaker S, Woolford T. Non‐melanoma skin cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(Suppl 2):S125‐S132. doi:10.1017/S0022215116000554
Kim JYS, Kozlow JH, Mittal B, et al. Guidelines of care for the management of cutaneous squamous cell carcinoma. J Am Acad Dermatol. 2018;78(3):560‐578. doi:10.1016/J.JAAD.2017.10.007
Berkowitz R, Vu J, Brummett C, Waljee J, Englesbe M, Howard R. The impact of complications and pain on patient satisfaction. Ann Surg. 2021;273(6):1127‐1134. doi:10.1097/SLA.0000000000003621
Lander JA, Weltman BJ, So SS. EMLA and amethocaine for reduction of children's pain associated with needle insertion. Cochrane Database Syst Rev. 2006;(3). doi:10.1002/14651858.CD004236.PUB2
Soueid A, Richard B. Ethyl chloride as a cryoanalgesic in pediatrics for venipuncture. Pediatr Emerg Care. 2007;23(6):380‐383. doi:10.1097/01.PEC.0000278396.25129.3F
MacLaren JE, Cohen LL. Interventions for paediatric procedure‐related pain in primary care. Paediatr Child Health. 2007;12(2):111. doi:10.1093/pch/12.2.111
Park SW, Oh TS, Choi JW, et al. Topical EMLA cream as a pretreatment for facial lacerations. Arch Plast Surg. 2015;42(1):28‐33. doi:10.5999/APS.2015.42.1.28
Irkoren S, Ozkan HS, Karaca H. A clinical comparison of EMLA cream and ethyl chloride spray application for pain relief of forehead botulinum toxin injection. Ann Plast Surg. 2015;75(3):272‐274. doi:10.1097/SAP.0000000000000121
Kim JE, Kim JY, Lee HS, Seok S, Kil HK. Analgesic effect of trigger point injection and EMLA for shoulder pain in patients undergoing total laparoscopic hysterectomy: a randomized controlled study. Medicine. 2019;98(2):e14087. doi:10.1097/MD.0000000000014087
Firdaus R, Sukmono B, Melati AC, Marzaini BD. Comparison between vapocoolant spray and eutectic mixture of local anesthetics cream in reducing pain during spinal injections. Anesthesiol Res Pract. 2018;2018:1‐5. doi:10.1155/2018/5050273
Thind D, Roberts SJ, van der Griend BF. Coolsense® versus EMLA® for peripheral venous cannulation in adult volunteers: a randomised crossover trial. Anaesth Intensive Care. 2021;49(6):468‐476. doi:10.1177/0310057X211039227
Tanaboonyawat S, Choontanom R. Cryoanalgesic versus EMLA® cream to reduced pain during analgesic injection in upper eyelid surgery: a randomized trial. Orbit. 2021;40(4):292‐294. doi:10.1080/01676830.2020.1789180
Milgrom P, Newton JT, Boyle C, Heaton LJ, Donaldson N. The effects of dental anxiety and irregular attendance on referral for dental treatment under sedation within The National Health Service in London. Community Dent Oral Epidemiol. 2010;38(5):453‐459. doi:10.1111/J.1600-0528.2010.00552.X
Hermanns H, Hollmann MW, Stevens MF, et al. Molecular mechanisms of action of systemic lidocaine in acute and chronic pain: a narrative review. Br J Anaesth. 2019;123(3):335‐349. doi:10.1016/J.BJA.2019.06.014
Engel SJ, Afifi AM, Zins JE. Botulinum toxin injection pain relief using a topical anesthetic skin refrigerant. J Plast Reconst Aesthetic Surg. 2010;63(9):1443‐1446. doi:10.1016/J.BJPS.2009.07.045
Health Products Regulatory Authority. Summary of Product Characteristics: EMLA 5%, Accessed January 7, 2024. https://www.hpra.ie/img/uploaded/swedocuments/Licence_PA1691-023-001_23112023115804.pdf
Hahn IH, Hoffman RS, Nelson LS. EMLA®‐induced methemoglobinemia and systemic topical anesthetic toxicity. J Emerg Med. 2004;26(1):85‐88. doi:10.1016/j.jemermed.2003.03.003
Franko OI, Stern PJ. Use and effectiveness of ethyl chloride for hand injections. J Hand Surg [Am]. 2017;42(3):175‐181. doi:10.1016/J.JHSA.2016.12.013
Rodriguez NA, Ascaso FJ. Ocular surface frostbite secondary to ethyl chloride spray. Cutaneous Ocul Toxicol. 2012;31(1):77‐80. doi:10.3109/15569527.2011.607201
Varkey B. Principles of clinical ethics and their application to practice. Med Princ Pract. 2021;30(1):17‐28. doi:10.1159/000509119
Mårtensson LB, Gunnarsson BM, Karlsson S, Lee N, Bergh I. Effect of topical local anaesthesia on injection pain associated with administration of sterile water injections—a randomized controlled trial. BMC Anesthesiol. 2022;22(1):35. doi:10.1186/S12871-022-01573-0
Moon YE, Kim SH, Seok H, Lee SY. Comparison of the effects of vapocoolant spray and topical anesthetic cream on pain during intraarticular injection of the shoulder: a randomized double‐blind controlled trial. Arch Phys Med Rehabil. 2020;101(10):1689‐1695. doi:10.1016/J.APMR.2020.04.021
Strazar AR, Leynes PG, Lalonde DH. Minimizing the pain of local anesthesia injection. Plast Reconstr Surg. 2013;132(3):675‐684. doi:10.1097/PRS.0B013E31829AD1E2
Bjerring P, Arendt‐Nielsen L. Depth and duration of skin analgesia to needle insertion after topical application of EMLA cream. Br J Anaesth. 1990;64(2):173‐177. doi:10.1093/BJA/64.2.173
Franko OI, Stern PJ. Use and effectiveness of ethyl chloride for hand injections. J Hand Surg [Am]. 2017;42(3):175‐181. doi:10.1016/J.JHSA.2016.12.013
Yagiela JA. Local anesthetics. In: Dionne R, ed. Management of Pain & Anxiety in the Dental Office. W. B. Saunders; 2002:78‐96. doi:10.1016/B0-7216-7278-7/50010-1
Mokashi A, Leatherbarrow B, Kincey J, Slater R, Hillier V, Mayer S. Patient communication during cataract surgery. Eye. 2004;18(2):147‐151. doi:10.1038/SJ.EYE.6700568
Wågø KJ, Skarsvåg TI, Lundbom JS, et al. The importance of needle gauge for pain during injection of lidocaine. J Plast Surg Hand Surg. 2016;50(2):115‐118. doi:10.3109/2000656X.2015.1111223
Joukhadar N, Lalonde D. How to minimize the pain of local anesthetic injection for wide awake surgery. Plast Reconstruct Surg Global Open. 2021;9(8):E3730. doi:10.1097/GOX.0000000000003730
Koja DB, Bede SY. Evaluation of buffered local anaesthesia in dental extraction: a randomized controlled study. Oral Surg. 2022;15(4):489‐495. doi:10.1111/ORS.12731
Birnie KA, Noel M, Chambers CT, Uman LS, Parker JA. Psychological interventions for needle‐related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev. 2018;2020(10):CD005179. doi:10.1002/14651858.CD005179.PUB4
Molleman J, Tielemans JF, Braam MJI, Weitenberg B, Koch R. Distraction as a simple and effective method to reduce pain during local anesthesia: a randomized controlled trial. J Plast Reconst Aesthet Surg. 2019;72(12):1979‐1985. doi:10.1016/J.BJPS.2019.07.023