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Pain Management 65
Table 11.1: Evidence-based research.
Title A comparison between EMLA cream application versus
lidocaine infiltration for post-operative analgesia after
inguinal herniotomy in children
Authors Usmani H, Pal Singh S, Quadir A, Chana RS
Institution Department of Anesthesia, Jawaharlal Nehru Medical
College, Aligargh Muslim University, Aligarh, India
Reference Reg Anesth Pain Med 2009; 34(2):106–109
Problem Postoperative pain relief following inguinal herniotomy.
Intervention Topical application of 5% EMLA cream before surgery or
wound infiltration with 1% lidocaine.
Comparison/ Study group comprised 90 children aged 4–12 years
control undergoing elective herniotomy under general anaesthetic.
(quality of Patients were randomly assigned to placebo cream
alone, 5% EMLA cream, or placebo cream + 1% lidocaine
evidence)
infiltration after induction of anaesthesia. Operative protocol
was standardised among groups. The requirement for
postoperative analgesia among groups was compared.
Outcome/ The number of patients requiring fentanyl as rescue
effect analgesia was significantly less in the study groups than in
the placebo group. Topical application of EMLA provided
postoperative pain relief comparable to infiltration with 1%
lidocaine.

Historical Suggests that the application of local anaesthetic cream
significance/ is a viable alternative to wound infiltration in the control of
comments postoperative pain. This would be a valuable strategy in
settings where clinical training and resources are limited.

Key Summary Points

1. Pain of some degree is almost universal in hospitalised the parent’s and child’s reports, the change in behaviour of
children, either as a result of underlying disease or the child, the measurement of physiological parameters and
interventions. knowledge of the underlying medical condition.
2. The recognition and subsequent management of pain is often 6. Cultural- and age-validated scoring tools should be routinely
inadequate in children. used in the assessment of pain in children.
3. Health care professionals have a moral obligation to provide 7. A combination of pharmacological and nondrug methods
the best possible management of children’s pain and should be should be used for managing pain.
trained in pain recognition.
8. Clinicians should anticipate pain in children and minimise the
4. The perception and expression of pain is highly dependent on number of potentially painful procedures to which a child is
the age and cognitive function of the child. subjected.
5. Accurate determination of the level pain is the first step to
adequate management and should take into consideration

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