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From Nurses' Drug Alert®

Lidocaine-Prilocaine in Preterm Infants

[Nurses' Drug Alert 23(11):88, 1999. © 1999 M.J. Powers & Co. Publishers]

Pediatric Medicine

Lidocaine-prilocaine (EMLA) cream was safe, but not effective, for relieving pain from heel lance in preterm infants.

Background: EMLA has been shown to be an effective topical anesthetic in infants >1 month old. It is not routinely used in newborn term infants or premature infants because of concerns that prilocaine metabolites may oxidize hemoglobin, inducing methemoglobinemia.

Methods: A total of 120 preterm infants were randomly assigned to treatment with either EMLA cream or placebo before a clinically indicated heel lance. Infants were 1-5 days old and had been delivered at gestational ages of 30-36 weeks. In Phase 1 of the experiment, involving about half of the patients, 0.5 g EMLA or placebo on an occlusive dressing was applied for 30 min before heel lance. When methemoglobinemia did not develop in any of the infants, the experiment proceeded to Phase 2, in which EMLA or placebo was applied for 60 min before heel lance. Pain was measured using the Premature Infant Pain Profile (PIPP), a 7-item score based on observation of facial expression, measurements of pulse rate and oxygenation, and the infant's gestational age and state of activation.

Results: Pain scores did not differ between treated and placebo groups in any of the PIPP items. No infant had clinical signs of methemoglobinemia, and average levels of methemoglobin did not increase significantly in the newborns receiving the active agent. About 10% of the infants had minor skin reactions (e.g., redness, swelling) at the heelstick site, and 20% had transient blanching following removal of the anesthetic cream.

Discussion: These observations are consistent with those of previous studies that showed no efficacy for EMLA in heel lance. However, the findings of safety add to existing data and promote investigation of the agent for other painful procedures in preterm infants.

Source of funding not stated.


1.Stevens B, et al: Management of pain from heel lance with lidocaine-prilocaine (EMLA) cream: is it safe and efficacious in preterm infants? Developmental and Behavioral Pediatrics1999;20 (August):216-221. From the University of Toronto, Ont., Canada; and other institutions.

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