Browne, 1999  Title: Topical amethocaine (Ametop) is superior
to EMLA for intravenous cannulation. Eutectic mixture of local
anesthetics.
Authors: Browne J, Awad I, Plant R, McAdoo
J, Shorten G
Journal: Can J Anaesth 1999 Nov;46(11):1014-8
PMID: 10566919, UI: 20031195
Affiliated institution: Department
of Anaesthesia and Intensive Care Medicine, Cork University Hospital
and University College Cork, Wilton, Ireland.
Cited in:
PURPOSE: A eutectic mixture of local anesthetics (EMLA) is commonly
used to provide topical anesthesia for intravenous (i.v.) cannulation.
One of its side effects is vasoconstriction, which may render
cannulation more difficult. A gel formulation of amethocaine (Ametop)
is now commercially available. The aim of this study was to compare
EMLA and Ametop with regard to the degree of topical anesthesia
afforded, the incidence of vasoconstriction and the ease of i.v.
cannulation.
METHODS: Thirty two ASA I adult volunteers had a #16 gauge i.v.
cannula inserted on two separate occasions using EMLA and Ametop
applied in a double blind fashion for topical anesthesia. Parameters
that were recorded after each cannulation included visual analogue
pain scores (VAPS), the presence of vasoconstriction and the ease
of cannulation, graded as: 1 = easy, 2 = moderately difficult,
3 = difficult and 4 = failed.
RESULTS: The mean VAPS +/- SD after cannulation with Ametop M
was 12+/-9.9 and with EMLA was 25.3+/-16.6 (P = 0.002). Vasoconstriction
occurred after EMLA application on 17 occasions and twice after
Ametop (P = 0.001). The grade of difficulty of cannulation was
1.44+/-0.88 following EMLA and 1.06+/-0.25 with Ametop (P = 0.023).
CONCLUSIONS: Intravenous cannulation was less painful following
application of Ametop than EMLA. In addition, Ametop caused less
vasoconstriction and facilitated easier cannulation. Its use as
a topical anesthetic agent is recommended, especially when i.v.
access may be problematic.
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