Pharmacologic Management
Available pharmacotherapies:
Lidocaine
Subcutaneous or intradermal anesthetics, such as lidocaine, are therapeutic options for the management of Peripheral Venous Access Pain. They provide rapid, and typically complete, local analgesia. The injection requires the use of a needle. Children's fear of needles can make the use of intradermal lidocaine a stressful experience.29
TLAs
Topical local anesthetics (TLAs) have been perceived to be limited by slow onset of action, resulting in treatment delays. In recent years, research has focused on the development of delivery systems for faster-acting topical agents.
Characteristics of EMLA®
and LMX4®
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EMLA
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LMX4/ELA-MAX
(OTC Product)
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INDICATION
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Topical anesthetic on normal intact skin or genital mucous membranes.30
(Full product indications are detailed in the product's package insert).
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For minor cuts and abrasions.31
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OFF-LABEL USE FOR PERIPHERAL VENOUS ACCESS PAIN
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Has been studied in patients prior to venipuncture32
and IV cannulation.33,34,35
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APPLICATION
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Apply cream in thick layer at site of procedure. Cover area with occlusive dressing. Wipe off thoroughly before procedure.30
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For the labeled indication, occlusive dressing not required but can be used. May consider covering application in young children to prevent accidental ingestion or removal of the cream.31
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DURATION OF PRETREATMENT
BEFORE PERIPHERAL
VENOUS ACCESS PROCEDURE
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At least 60 minutes30
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Clinical studies used a
30-minute application prior to venous access procedures.32,33-34
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COMMON ADVERSE REACTIONS
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In patients treated with EMLA Cream on intact skin, local effects observed in the trials included: paleness (pallor or
blanching), redness (erythema), alterations in temperature sensations, edema, itching, and rash.30
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Irritation, itching, redness, and rash.31
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