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Topical lidocaine-prilocaine cream (EMLA) for thoracostomy tube removal.

Author(s): Valenzuela RC, Rosen DA

Affiliation(s): Department of Anesthesiology, West Virginia University, Morgantown, USA.

Publication date & source: 1999-05, Anesth Analg., 88(5):1107-8.

Publication type: Clinical Trial; Randomized Controlled Trial

We prospectively studied topical lidocaine-prilocaine cream (EMLA) versus IV morphine in a double-blinded, randomized fashion for pain relief during thoracostomy tube (chest tube; CT) removal. Adult patients who had undergone thoracotomy or median sternotomy were randomized to receive either EMLA cream over CT sites transdermally for 3 h or IV morphine 0.5 h before CT removal. Pain behavior was observed and rated before, during, and after CT removal. Pain behavior increased less in the topical EMLA group (mean +/- SE, 4.4+/-0.39) compared with the IV morphine group (6.0+/-0.38; P < 0.01). No signs of infection were noted at the CT sites 24 or 48 h after CT removal. We conclude that EMLA cream is more effective than IV morphine in preventing the pain associated with CT removal. IMPLICATIONS: Postoperatively applying a topical anesthetic cream onto chest tube sites of chest surgery patients 3 h before chest tube removal is more effective than IV morphine in blunting pain response.

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