We evaluated the analgesic efficacy of a 5% eutectic mixture of lidocaine and prilocaine (EMLA®) topically applied before performing skin puncture for spinal or epidural anesthesia.

The patient population consisted of 75 ASA physical status 1 and 2 adults scheduled for operations of the lower abdominal region, the perineal region or the lower extremities. The patients were randomly allocated to one of five groups of equal size: group A - topical application of EMLA® cream 120 min before spinal block; group B - subcutaneous infiltration of 2 ml of 2% lidocaine immediately before spinal block; group C - no pretreatment before spinal block; group D - topical application of EMLA® cream 120 min before epidural block; and group E - subcutaneous infiltration of 2 ml of 2% lidocaine immediately before epidural block. Pain experienced during the whole procedure was rated using a 10 cm visual analogue scale.

Patients in group A experienced less pain compared with those in groups B and C (2.0 ± 1.9 cm vs 4.1 ± 1.9 cm and 3.9 ± 2.2 cm, respectively; P < 0.05). However there was no significant difference between group D and group E (3.6 ± 2.4 cm vs 4.1 ± 2.5 cm). The patients in group A and group D were highly satisfied with the method of analgesia (P < 0.05).

EMLA® cream is an effective alternative to subcutaneous infiltration of local anesthetic for analgesia during skin puncture using a 25 G spinal needle. It provides insufficient analgesia however for epidural anesthesia.