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PEDIATRICS Vol. 104 No. 3 September 1999, p. e31

ELECTRONIC ARTICLE:
Relative Efficacy of Amethocaine Gel and Lidocaine-Prilocaine Cream for Port-a-Cath Puncture in Children

Received Jan 27, 1999; accepted Apr 1, 1999.

Raafat Bishai*, Anna TaddioDagger , §, Benjamin Bar-Oz*, Melvin H. Freedmanparallel , , and Gideon Koren*, §,

From the Departments of * Paediatrics, Dagger  Pharmacy, and parallel  Hematology/Oncology, Hospital for Sick Children; and the Faculties of  Medicine and § Pharmacy, University of Toronto, Toronto, Ontario; and the CIBC Wood Gundy Children's Miracle Foundation Chair in Child Health Research (G.K.).

Background. Lidocaine-prilocaine cream (EMLA) is currently standard therapy to alleviate procedural pain in children. One of the disadvantages of lidocaine-prilocaine is the need to wait for 60 minutes for adequate skin anesthesia. Amethocaine gel (Ametop) is a new topical anesthetic that requires a shorter application time for skin anesthesia.

Objectives.  To compare the relative efficacy and safety of amethocaine gel and lidocaine-prilocaine cream in children with cancer undergoing Port-a-Cath puncture and to determine which patient factors influence judgments about pain.

Methods.  Randomized, blinded, crossover study. Each child received either 1 g of amethocaine gel for 30 minutes, preceded by a placebo gel for 30 minutes, or 1 g of lidocaine-prilocaine cream for 60 minutes. Children rated the pain using the faces scale, for which scores ranged from 0 to 5. Parents and attending nurse operators rated pain on a 10-cm visual analog scale.

Results.  Thirty-nine children participated. The mean age was 10.2 years (range: 5-16 years), and 69% were male. There were no differences in mean pain assessments between amethocaine and lidocaine-prilocaine as rated by the children (2.0 vs 0.5), parents (2.6 vs 6.4), or nurse operators (2.0 vs 0.9). No serious adverse effects were detected with either preparation. Pain scores assigned by parents and children were not influenced by age, gender, duration of diagnosis, or anesthetic regimen (amethocaine versus lidocaine-prilocaine) in the child. Nurses, however, rated pain higher for younger children, and in males during pretreatment with lidocaine-prilocaine.

Conclusion.  Amethocaine achieves similar anesthesia to lidocaine-prilocaine during Port-a-Cath administration in children, with an application time that is half of lidocaine-prilocaine. Pain assessments were not influenced by age, gender, or duration of diagnosis of the child. Nurses may perceive that pain is greater for younger children and in males. lidocaine-prilocaine, amethocaine, pain, children, Port-a-Cath puncture.

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