A randomized, double-blind comparison study of EMLA® and ELA-Max® for topical anesthesia in children undergoing intravenous insertion

Background: Topical anesthetics may help reduce discomfort associated with procedures involving needle-puncture, such as intravenous (i.v.) insertions, in children. EMLA(R) cream has become a common, noninvasive therapy for topical anesthesia in children. ELA-Max(R) is a recently introduced topical anesthetic cream marketed as being as effective in producing topical anesthesia after a 30-min application as EMLA(R) is after a 60-min application. The purpose of this research was to compare ELA-Max(R) at 30 min with EMLA(R) at 60 min for providing topical anesthesia for i.v. insertions in children. Methods: Sixty children, ages 8-17 years, requiring an i.v. were randomized to receive either the 30 min application of ELA-Max(R) (n = 30) or the 60 min application of EMLA(R) (n = 30). Children rated any pain associated with the i.v. insertion using a 100-mm Visual Analog Scale (VAS). The anesthesiologist assessed the presence of blanching at the site and rated the difficulty of placing the i.v. Results: There was no clinically or statistically significant difference in pain ratings (P = 0.87) between the ELA-Max(R) (mean = 25.7) and the EMLA(R) (mean = 26.8) groups. ELA-Max(R) caused significantly (P = 0.04) less blanching than EMLA(R), however there was no difference in the anesthesiologists' rating of the difficulty of the i.v. placement between the groups (P = 0.73). Conclusion: Results from this study support the claim that a 30-min application of ELA-Max(R) (with occlusion) is as effective as a 60-min application of EMLA(R) (with occlusion) for producing topical anesthesia for i.v. insertion in children.