The Eutectic Mixture of Local Anesthetics (EMLA) is an emulsion of lignocaine and prilocaine, used for topical application to relieve paine I), Although it has been found both safe and efficacious in children, it has not come into common usage in newborns be- cause of concerns surrounding its safety and efficacy.

Five trials have demonstrated the utility of EMLA in newborns for relieving the pain associated with circumcision, percutaneous line insertion, cutaneous hypersensitivity due to heelpricks, venipuncture and arterial puncture; and the benefit of EMLA has been documented both in preterm and in term infants (2-7). EMLA has not been found efficacious in ameliorating the pain of heelpricks and lumbar punctures, and also of venepuncture in preterm infants(8-ll).

The major concern with the use of EMLA in newborns has been the risk of methemoglobinemia. Clinically significant methemoglobinemia requiring therapy has been reported in only one case so far, although it may have been compounded by the concomitant use of a sulfonamide(l2). One study on preterm. infants, who received EMLA before heelpricks, showed that methemoglobin levels did not rise; however another report showed a higher concentration of methemoglobin in preterms undergoing venepuncture(7,II).

EMLA is best used as a single dose before an elective procedure in term babies. The disadvantages are that it requires an application time of at least 45 minutes and hence cannot be used before urgent procedures; the safety of repeated applications is undocumented, and it cannot be used on patients with methaemoglobinemia or on those receiving therapy with methaemoglobin inducing agents. Its use in preterm infants remains controversial.
 

Sourabh Datta,
Assistant Professor,
Department of Pediatrics,
Postgraduate Institute of
Medical Education and Research, Chandigarh 160 012,
India.
 

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