UNLABELLED: Most medications are not absorbed topically due to the stratum corneum barrier. While effective as a topical anesthetic, EMLA cream is absorbed slowly, delaying its effects for up to one hour, thereby limiting its usefulness. OBJECTIVE: To determine whether removal of the cornified layer of the skin by tape stripping (TS) would allow more rapid onset of anesthesia after topical application of EMLA cream prior to IV catheterization (IVC). METHODS: This was a prospective, randomized, controlled trial comparing the levels of pain of IVC 15 minutes after topical application of EMLA cream in patients who had TS vs patients who did not. The setting was a suburban university-affiliated ED. A convenience sample of 68 alert adult patients requiring IVC were enrolled. The primary outcomes measured were pain of IVC and pain of TS using a previously validated 100-mm visual analog scale as well as the IVC success rate. RESULTS: The pain of IVC was less for TS vs control patients [29.7 mm (95% CI=20.4 to 39.0 mm) vs 15.9 mm (95% CI=9.1 to 22.6 mm), p=0.017]. The mean pain of TS was 4.8+/-7.4 mm. The IVC success rate for TS vs control patients was 91% vs 74% (p=0.056). There were no adverse events after TS. CONCLUSIONS: Removal of the cornified layer of the skin resulted in a more rapid anesthetic effect of EMLA cream as evidenced by lower IVC pain scores after TS. The effectiveness of TS for enhanced absorption of other medications should be investigated.
RCT Entities:
UNLABELLED: Most medications are not absorbed topically due to the stratum corneum barrier. While effective as a topical anesthetic, EMLA cream is absorbed slowly, delaying its effects for up to one hour, thereby limiting its usefulness. OBJECTIVE: To determine whether removal of the cornified layer of the skin by tape stripping (TS) would allow more rapid onset of anesthesia after topical application of EMLA cream prior to IV catheterization (IVC). METHODS: This was a prospective, randomized, controlled trial comparing the levels of pain of IVC 15 minutes after topical application of EMLA cream in patients who had TS vs patients who did not. The setting was a suburban university-affiliated ED. A convenience sample of 68 alert adult patients requiring IVC were enrolled. The primary outcomes measured were pain of IVC and pain of TS using a previously validated 100-mm visual analog scale as well as the IVC success rate. RESULTS: The pain of IVC was less for TS vs control patients [29.7 mm (95% CI=20.4 to 39.0 mm) vs 15.9 mm (95% CI=9.1 to 22.6 mm), p=0.017]. The mean pain of TS was 4.8+/-7.4 mm. The IVC success rate for TS vs control patients was 91% vs 74% (p=0.056). There were no adverse events after TS. CONCLUSIONS: Removal of the cornified layer of the skin resulted in a more rapid anesthetic effect of EMLA cream as evidenced by lower IVC pain scores after TS. The effectiveness of TS for enhanced absorption of other medications should be investigated.
Authors: Christian Weilbach; Christian Hoppe; Matthias Karst; Michael Winterhalter; Konstantinos Raymondos; Arthur Schultz; Niels Rahe-Meyer Journal: J Pain Res Date: 2017-05-10 Impact factor: 3.133