Topical Amethocaine versus Topical Eutectic Mixture of Local Anaesthetic (EMLA)

Children's distress and pain from intravenous cannulation is reduced with the use of topical anaesthetic cream. At Starship children’s emergency department (CED) we use EMLA (Eutectic Mixture of Local Anaesthetic) and are very satisfied with its effect. A recent Cochrane systematic review suggests that Amethocaine is a better topical anaesthetic (1). Amethocaine works faster and has better pain relieving abilities than EMLA independent of application time. There is even a suggestion that Amethocaine may improve success rates for IV access although the evidence was inconclusive. EMLA is a vasoconstrictor, which appears to constrict veins whereas Amethocaine is a vasodilator and causes local erythema. Amethocaine has traditionally been more expensive than EMLA. The Cochrane review found two clinical questions unanswered; does Amethocaine improve cannulation success rate and what are the cost implications? This research project will attempt to answer these questions by comparing the use of EMLA and Amethocaine for topical anaesthesia in children undergoing intravenous cannulation at Starship CED. 1. Lander JA, Weltman BJ and So SS. EMLA and Amethocaine for reduction of children’s pain associated with needle insertion (Review). Cochrane Database of Systematic Reviews. (3). 2006.