Takeaway
- EMLA cream offers minimal benefits vs placebo for reducing pain for infants undergoing venipuncture, with moderate-quality evidence in this meta-analysis.
- It offers no benefits vs breastfeeding or sucrose solution.
- A risk is elevated methemoglobin.
Why this matters
- These authors say that based on their findings, "clinicians may want to avoid the routine use of EMLA before venipuncture in term and preterm infants.”
Key results
- EMLA vs placebo/sucrose/breast milk for pain:
- Standardized mean difference (MD): 0.14 (95% CI, −0.17 to 0.45; 6 trials, n=742; I2=71%; moderate-quality evidence).
- EMLA linked to increased methemoglobin levels vs placebo:
- MD: 0.35% (95% CI, 0.04%-0.66%; 2 trials, n=134; low-quality evidence).
- Risk for skin blanching increased with EMLA.
- Crying, heart rate reductions not steeper and O2 saturation did not differ with EMLA vs placebo or sucrose.
- Among term infants, sucrose or breast milk bested EMLA:
- Standardized MD, 0.44 (95% CI, 0.22-0.58; 3 and 5 trials, n=496; I2=0%).
Study design
- Meta-analysis, 10 randomized controlled trials (n=917) of EMLA vs sucrose, breast milk.
- Funding: No external funding.
Limitations
- Results possibly not applicable for older infants.
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