The application of the lidocaine-prilocaine cream led to a significant reduction of pain compared with the placebo.

the pain or discomfort at the injection site that some patients experience (1). A recent study found that the severity of pain that patients experienced during an injection was correlated with their attitude toward the injection (3), and thus depot-associated pain might affect patient compliance as well.

Lidocaine-prilocaine cream has enjoyed increasing popularity as a local anesthetic to prevent pain from various minor medical and surgical procedures, including intramuscular injections, without aggravating anticipatory anxiety (4,5)

the possibility of ameliorating pain from injections might have a parallel beneficial effect in enhancing medication compliance. Although our study did not examine long-term effect and compliance, the fact that one of our previous studies (3) showed a correlation between the pain that patients' experienced from an injection and their attitude toward the injection leads one to believe that the use of a local anesthetic could facilitate medication compliance. Although there are beneficial effects of using a local anesthetic cream, one should note that there is the inconvenience of waiting an hour to give the injection after the cream is applied. In clinical practice this waiting period can be managed by giving patients the possibility of applying the local anesthetic cream at home, either by themselves or with the help of caregivers. 

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https://doi.org/10.1111/j.1651-2227.2001.tb01584.x

A randomized double-blind, placebo-controlled trial of the EMLA® patch for the reduction of pain associated with intramuscular injection in four to six-year-old children

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The effectiveness of a eutectic mixture lidocaine-prilocaine topical anesthetic cream (EMLA®) patch compared with a placebo patch in the reduction of pain associated with intramuscular immunization was evaluated. As part of the study, 161 children (aged 4-6-y) undergoing routine diphtheria, pertussis, tetanus and polio (DPTP) immunization in five urban and five rural private office settings were randomly assigned to an EMLA® patch (n= 83) or a placebo patch control group (n= 78). Pain measurements included: child's self-report on a Faces Pain Scale; facial action on the Child Facial Coding System; the Children's Hospital of Eastern Ontario Pain Scale and parent and technician ratings on a Visual Analogue Scale. Parents also rated their own and their child's immunization-related anxiety on a Visual Analogue Scale. The EMLA® patch group had significantly less pain on all four pain measures compared with the placebo group. Of the children in the placebo group, 43% had clinically significant pain, compared with 17% of children in the EMLA® patch group. No severe adverse symptoms occurred as a result of either EMLA® or placebo patch application.

Conclusion: The EMLA® patch reduced immunization pain in 4 to 6-y-old children during needle injection.

Mandy L. Kohli, Reza Vali, Afsaneh Amirabadi, Caroline A. Frankfurter, Ardavan Nateghi, Eman Marie, Amer Shammas, Procedural pain reduction strategies in paediatric nuclear medicine, Pediatric Radiology, 10.1007/s00247-019-04462-w, (2019).

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