Thickly and thinly applied lignocaine-prilocaine cream prior to venepuncture in children

EMLA cream (Astra Pharmaceuticals) which contains lignocaine and prilocaine, is widely used in a thick layer to reduce the pain associated with venepuncture. Application of smaller amounts of cream lowers cost and may reduce side-effects. The efficacy of a thick layer (using 2.0 ml) and a thin layer (using 0.5 ml) of lignocaine-prilocaine cream prior to venepuncture was compared in a randomised study of one hundred children. Pain with venepuncture was assessed using a behavioural rating scale as none, slight, moderate or severe. Children in the thin layer study group experienced slight pain more often than children in the thick layer study group (P less than 0.01). No child in either group experienced moderate or severe pain. It is concluded that a thin layer of lignocaine-prilocaine cream is not as effective as a thick layer in producing the pain-free venepuncture which is desirable in children.