Research Article

Comparison the Efficacy of EMLA Cream versus EMLA with High Frequency Sonophoresis in Decreasing Onset Time to Topical Anaesthesia in Adult Volunteers: A Pilot Study

Abstract

Background: Sonophoresis or phonophoresis is a well-known transdermal drug delivery mechanism. Usage of high frequency ultrasound for sonophoresis was initiated in late 1950s while the usage of low-frequency sonophoresis was investigated significantly during the past two decades. The objective was to analyze the efficacy of high frequency ultrasound probe in the penetration of EMLA cream in decreasing onset time for topical anaesthesia in adult healthy volunteers.
Methods: A prospective, open labelled, comparative study was conducted on patients reporting at the Pain Clinic our institute. Subjects received the intervention USG probe with EMLA either on the left or the right hand based on a random number chart, with the other hand of the same subject acting as a control. In group USG, the probe was applied directly on the cream without any added pressure. Sensory testing was done every 10 minutes by pin prick on both the hands of the patients NRS scores of both the hands were recorded at 10.20,30 and 40 minutes.
Results: Total 20 patients were selected for the study. Although a significant decrease in the pain scores in both the groups was observed after 40minutes, (p<0.05) both the groups are comparable at each point of time. We could not find any significant decrease in pain scores when groups are compared in intervals during the study period.
Conclusion: There is no significant difference in decreasing the intensity of pain scores upon application of ultrasound over EMLA in an adult population. Further studies have to be done to prove the efficacy in a larger population and pediatric ones

[1] Polat BE, Hart D, Langer R, Blankschtein D. Ultrasound-mediated transdermal drug delivery: mechanisms, scope, and emerging trends. J Control Release. 2011; 152(3):330-48.
[2] Azagury A, Khoury L, Enden G, Kost J. Ultrasound mediated transdermal drug delivery. Adv Drug Deliv Rev. 2014; 72:127-43.
[3] Smith NB. Perspectives on transdermal ultrasound mediated drug delivery. Int J Nanomedicine. 2007; 2(4):585-94.
[4] Oberli MA, Schoellhammer CM, Langer R, Blankschtein D. Ultrasound-enhanced transdermal delivery: recent advances and future challenges. Ther Deliv. 2014; 5(7):843-57.
[5] Tanya LR, Lyne OC. The use of EMLA cream to decrease venepuncture pain in children. J Pediatr Nurs. 2004; 19(1):33-9.
[6] Friedman PM, Mafong EA, Friedman ES, Geronemus RG. Topical anesthetics update: EMLA and beyond. Dermatol Surg. 2001; 27(12):1019-26.
[7] Browne J, Awad I, Plant R, McAdoo J, Shorten G. Topical amethocaine is superior to EMLA for intravenous cannulation. Can J Anesth. 1999; 46(11):1014-8.
[8] Hallen B, Olsson GL, Uppfeldt A. Pain‐free venepuncture: Effect of timing of application of local anaesthetic cream. Anaesthesia. 1984; 39(10):969-72.
[9] Hopkins CS, Buckley CJ, Bush GH. Pain‐free injection in infants: Use of a lignocaine‐prilocaine cream to prevent pain at intravenous induction of general anaesthesia in 1–5‐year‐old children. Anaesthesia. 1988; 43(3):198-201.
[10] Cordoni A, Cordoni LE. Eutectic mixture of local anesthetics reduces pain during intravenous catheter insertion in the pediatric patient. Clin J Pain. 2001; 17(2):115-8.
[11] Seah BC, Teo BM. Recent advances in ultrasound-based transdermal drug delivery. Int J Nanomedicine. 2018; 13:7749-63.
[12] Feiszthuber H, Bhatnagar S, Gyöngy M, Coussios CC. Cavitation-enhanced delivery of insulin in agar and porcine models of human skin. Phys Med Biol. 2015; 60(6):2421-34.
[13] Yu ZW, Liang Y, Liang WQ. Low-frequency sonophoresis enhances rivastigmine permeation in vitro and in vivo. Pharmazie. 2015; 70(6):379-80
[14] Pereira TA, Ramos DN, Lopez RF. Hydrogel increases localized transport regions and skin permeability during low frequency ultrasound treatment. Sci Rep. 2017; 7:44236.
[15] Hadgraft J. Skin deep. Eur J Pharm Biopharm. 2004; 58(2):291-9.
[16] Williams AC. London: Pharmaceutical Press; 2003. Transdermal and topical drug delivery: From theory to clinical practice.
Files
IssueVol 6 No 4 (2020): Autumn QRcode
SectionResearch Article(s)
DOI https://doi.org/10.18502/aacc.v6i4.4635
Keywords
EMLA cream Sonophoresis

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Adabala V, Kumar A, Talawar P, Dhar M, Ravi G. Comparison the Efficacy of EMLA Cream versus EMLA with High Frequency Sonophoresis in Decreasing Onset Time to Topical Anaesthesia in Adult Volunteers: A Pilot Study. Arch Anesth & Crit Care. 2020;6(4):152-155.