EMLA cream prior to insertion of elective epidurals

A randomized double-blind study was conducted in 83 women scheduled for elective caesarean section to determine the efficacy of EMLA and lignocaine infiltration for epidural insertion. The patients were randomly allocated to one of three groups: Group A (EM/LIG) received EMLA and intradermal and subdermal 1% lignocaine infiltration, Group B (EM/SAL) EMLA and saline while Group C (PL/LIG) received placebo cream and 1% lignocaine. Assessments using a 100 mm pain score were performed on skin infiltration and after subsequent insertion of a 16 gauge Tuohy needle into the supraspinous ligament. Skin changes under the applied cream and nursing rating of patients' response were also noted. Statistical analyses were performed using Kruskal-Wallis and Fisher's Exact Tests. Groups were comparable for age, weight, parity and EMLA application time (interquartile range 105-150 minutes). There were significantly higher pain scores for skin infiltration in Group C (PL/LIG) (P < 0.01) and for epidural needle insertion in Group B (EM/SAL) (P < 0.05). We concluded that in this patient population, the application of EMLA cream for at least 90 minutes plus 1% lignocaine infiltration optimized patient comfort for epidural insertion.