EMLA cream for infant venipuncture: help or hype?

  • Shahid S & al.
  • Pediatrics
  • 26 Dec 2018

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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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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