The efficacy of prilocaine-lidocaine cream %5 (EMLA)) in alleviating the pain of spinal needle as compared with intravenous fentanyl

The anxiety and pain that patients feel on their skin is one of the disadvantages of the spinal anesthesia, which is a frequently preferred method since it is a fast and reliable way of inferior body injections. In this study, we aimed to compare the analgesic activities of 5% Prilocaine-lidocaine (EMLA) with 1 µg/kg intravenous fentanyl prior to spinal anesthesia injection.The sample of the study was 75 male patients of ASA I-II groups with the age range from 20 to 65, who were planned to be subjected to elective urological surgery under the influence of spinal anesthesia. After obtaining ethics committee approval and written informed consents of each patient, the sample was randomly divided into three groups (EMLA Group, Fentanyl Group, Control Group) each of which with 25 patients. All the groups were subjected to standard premedication. For EMLA group, 2,5g of EMLA cream was applied on the injection area, 45 minutes prior to the spinal anesthesia injection. For Fentanyl group, 1 µg/kg Fentanyl iv Bolus was applied 10 minutes prior to the injection. On the other hand, no analgesic or local anesthetic was applied on the injection area of the patients in the control group. Since the pain level can be affected from sedation state and anxiety, standard anxiety level was measured and recorded with APAIS-A Anxiety Score, 5 minutes prior to the spinal anesthesia injection and the sedation level was determined with Ramsay Sedation Scale (RSS) at 4 different times. Spinal anesthesia was performed at L4-L5 disc interspace with 22-Gauge Spinal Needle. The pain felt on the skin caused by the penetration of the needle was evaluated with Verbal Rating Scale (VRS) ranging from 0-4. Local tissue reactions (erythema, paleness, edema) and other side effects were monitored. Average Arterial Pressure (AAP), heart beat rate (HBR) and SpO2 values were recorded before and after the injection. In addition, patient satisfaction, the quality of the procedure and irritation responses were also evaluated.VRS scores of EMLA group were significantly lower than the rest. However there was no significant difference between VRS scores of Fentanyl and control groups. Patient satisfaction level of the EMLA group was higher comparing to Fentanyl and control groups while there was no significant difference between Fentanyl and control groups. Frequency of irritation reactions were less in the EMLA group than Fentanyl and control groups. Concerning irritation frequency there was no significant difference between Fentanyl and control groups. The process quality percentile of the EMLA group was higher than Fentanyl and control groups. It was higher in Fentanyl group than the control group. Concerning side effects, no local skin reactions in EMLA group and no respiratory and cardiac side effects in Fentanyl group were observed. There were no significant differences among AAP, HBR and SpO2 values of the three groups.As a result, it was concluded that; in the alleviation of spinal needle pain, EMLA cream applied 45 minutes prior to injection is superior to both application of 1 µg/kg intravenous Fentanyl and the control group in terms of analgesic activity, patient satisfaction and process quality.Keywords: Spinal Anesthesia, EMLA, Fentanyl, Acute Pain