The efficacy of LMX versus EMLA for pain relief in boys undergoing office meatotomy

Purpose: We determined if a difference in pain management occurred when topical anesthetics LMX (formerly ELA-Max, lidocaine 4%) and EMLA (lidocaine 2.5% and prilocaine 2.5%) were compared in boys undergoing office meatotomy for symptomatic meatal stenosis. Materials and Methods: A prospective randomized study was performed on 52 boys who underwent office meatotomy by a single pediatric urologist. Of the boys 26, 2 to 9 years old (mean age 4.4) underwent meatotomy 45 minutes after topical anesthetic application (LMX 13, EMLA 13) between February and December 2001, 26, ages 1 to 10 years old (4.6) underwent meatotomy 30 minutes after topical anesthetic application (LMX 13, EMLA 13) between April 2002 and January 2003. A single pediatric urological nurse performed pain assessment using the WongBaker Faces scale before applying the anesthetic ointment and immediately following the procedure. Each child had either LMX or EMLA applied and covered with an occlusive dressing for either 45 or 30 minutes before the procedure. Oral acetaminophen (10 mg/kg) was given at the time of anesthetic application. A meatotomy was then performed using a straight crushing hemostat for 1 to 2 minutes followed by incision. Mann-Whitney rank sum test was implemented to determine statistical significance. Results: Excellent procedure outcomes were experienced by all patients without recurrent meatal stenosis. Conclusions: There was no significant difference between LMX and EMLA when applied 45 minutes before meatotomy. When applied 30 minutes before meatotomy LMX provided significantly superior pain management than EMLA.