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Multiple puncture technique using anaesthetic cream (emla)

Discussion in 'General Issues and Discussion Forum' started by richardrobley, Feb 4, 2012.

  1. richardrobley

    richardrobley Active Member

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    Has anyone ever tried Emla anaesthetic cream when performing v/p multiple puncture technique on patients who do not want an anaesthetic injection. Very curious as a lot of patients are put off by the thought of having a painful anaesthetic.
  2. MJJ

    MJJ Active Member

    I imagine you would be replacing ceiling tiles fairly quickly, given the depth that you have to insert the needle.
  3. richardrobley

    richardrobley Active Member

    Checked some nursing sites and it's often used on children when fitting canula's, which are quite deep. Can also be used for skin grafts and minor skin operations??
  4. TDC

    TDC Member

    Hi Richard,

    From what i've read the elma cream is only effective in anaesthetising plantar skin in children and has no significant effect in adults.
  5. Admin2

    Admin2 Administrator Staff Member

  6. blinda

    blinda MVP

    Hi Richard,

    In my opinion, which isn`t to say is correct, Emla cream (which has to be correctly applied at least 2 hours prior to tx) is messy and rubbish. It is only a dermal anaesthesia so does not penetrate to the subcutaneous tissue where the needle must be inserted multiple times for VP tx.

    I often use ethyl chloride as a pre-injection `numb-er`. It`s quick and effective.

    Tip; Don`t underestimate the power of suggestion. NEVER use the phrase "painful anaesthetic". LA is utilised to render what would otherwise be painful procedures, painless. Pain is incredibly subjective and pts pick up on any spoken, or unspoken, hints that you as their health professional give them. Personally, I advise them that the injection does smart, but no more than an inoculation in the arm, which most can identify with and often reduces their unease.

    Just my view, of course.
  7. twirly

    twirly Well-Known Member

    I agree with Bel & other posters that Emla cream is likely to be of little use. I also sometimes use Ethyl Chloride pre- injection. I also agree that avoiding the 'needle' word is a very good idea. I always lay the patient down & tell them I will ask them to take a deep breath & then to breathe normally. I have found children respond better if I ask them to count slowly from 5 to 0. The only failed injection was with my daughter! She required a general anaesthetic & a consultant podiatric surgeon plus a full theatre team including consultant anaesthetist to perform a partial nail avulsion! She even needed Entonox prior to siting the cannula. Epic bloody fail!

    Whoever said never work with children or animals was right on the money. :eek:


  8. I can guarentee that it would make your patients confess!! No, its a horrible idea which would never work. Try it on yourself.

    I generally ask patients how painful they found the tib block on a scale of one to ten. Its very rare that they say more than 3. A well executed tibial block is almost painless.
  9. blinda

    blinda MVP

    As is any block, with the right technique. Hows about completing that challenge, eh Smelly?
  10. richardrobley

    richardrobley Active Member

    Before I posted this question I was actually thinking of trying it on myself. Maybe I should, and video it! It could be the funniest video on here, lol
  11. blinda

    blinda MVP

    It`s the way to go. Best way I found of administering LA with the least amount of discomfort was by practising on myself....

    I actually used to have a needle phobia, but that`s another story.
  12. richardrobley

    richardrobley Active Member

    Bet that wasn't the best day you've ever had, lol.
  13. blinda

    blinda MVP

  14. DTT

    DTT Well-Known Member

    I/v canulation in children is usually via a butterfly canulae which is then used to administer any anaesthetic / drug required during surgery (a very small gauge needle which saves making their arm like a pin cushion:D).

    It is in effect a very superficial procedure as the object is to canulate a supeficial vein.

    Adults on the other hand in emergency blood loss situations may need the equivilent of a drain pipe or two intoduced into their venous system to carry a variety of large volume fluids:eek:.

    The child may get the emla cream which at best lessens the needle stick side of it.

    The adult in the circumstances described has no choice


    In either scenario in my experience with the right technique neither should find it too much of a trial:drinks.

    I have a rule in my practice which I think is somewhat overlooked in this profession...


    Ask yourselves with modern day anaesthetics properly administered, is there any reason for that not to be true??????

    And BTW NOOOOOOOOOOOOOO you wouldnt use emla to provide anaesthesia in multiple needling because the patient would be screaming in pain before you had get past the second application of the needle !!Please try it on yourself and then see if you want to try it on others....NOT

    Last edited: Feb 5, 2012
  15. Jose Antonio Teatino

    Jose Antonio Teatino Well-Known Member

    better a posterior tibial block ...
  16. cjhopper1

    cjhopper1 Active Member

    As a pond life student my view having seen the procedure and being told you need to penetrate 5-7mm into the VP, a tibial block is the way to go. If the patient is needle phobic you could use Entonox for both its Analgesic and Anxiolytic properties (Plenty of research on its use in cannulation and other painful procedures) and it is a Pharmacy item, not a POM :)

  17. Seamus McNally

    Seamus McNally Active Member

    You cannot compare going 5-7 mm into the skin (puncture technique) with cannulisation. The Emla is only used in cannula insertion to numb the point of entry, in the skin, of the needle. The needle enters the vessel at a superficial level. I think most topical anaesthetics are placebo in effect as they really only work on mucous membrane -e.g. the gums.
  18. W J Liggins

    W J Liggins Well-Known Member

    Absolutely agree.

    As other posters have stated, we have the ability to use tibial blocks, we're skilled at them, most other professions are not. Play to your strengths and use that which have been proved beyond doubt to be effective rather than experimenting with that which has proved to be ineffective and reap the huge benefits for both your patient and yourself.

    All the best

    Bill Liggins
  19. I rarely use a posterior tibial nerve block for doing the needling technique for plantar verrucae, but, rather, I use ethyl chloride spray to numb (i.e. temporarily freeze) the skin before giving the local anesthetic injection. Generally, 5-10 seconds of ethyl chloride spray at the desired site of needle puncture eliminates any pain from the initial needle stick. However, ethyl chloride spray does not prevent the discomfort from injection of the local anesthetic subdermally (which is generally mild). Care is taken to inject very slowly into the subdermal area of the plantar verrucae since pushing fluid too fast into the injection site causes increased pain. It takes about 5 minutes from the time the needle goes in for the local anesthetic injection until the time I can do the needling procedure for the verrucae plantaris lesion, with no pain whatsoever noted during the needling procedure.

    Here is the ethyl chloride spray I use on a daily basis in my office for all injections. It simply is the best way to give injections, as far as I'm concerned.
  20. richardrobley

    richardrobley Active Member

    Thanks Kevin, that's really interesting, much appreciated.
  21. blinda

    blinda MVP

    Indeed :drinks

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