EFFECT OF EMLA (EUTECTIC MIXTURE OF LOCAL ANESTHESIA) 5 % CREAM VS LIGNOCAINE GEL 2% FOR ATTENUATION OF EXTUBATION RESPONSE AND POSTOPERATIVE SORE THROAT IN PATIENTS UNDERGOING GENERAL ANAESTHESIA IN A TERTIARY CARE UNIT – A RANDOMIZED COMPARATIVE STUDY
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Keywords
EMLA Cream, Eutectic Mixture, Postoperative Sore Throat, Extubation Response.
Abstract
BACKGROUND: The endotracheal intubation response is known to cause significant physiological and dynamic changes and postoperative sore throat in patients undergoing general anesthesia.
METHODOLOGY: A Randomised Controlled trial was organized at a tertiary care hospital. The patients were eligible for inclusion in the trial if they were ASA 1 or 2 patients requiring general anesthesia under endotracheal intubation. The primary end point included cardiovascular reactions during endotracheal intubation, extubation responses, and post-operative sore throat during recovery. In the test group, 2 g of lidocaine/prilocaine (EMLA) cream and in the control group, 2 g of lignocaine were applied to the surface of the tracheal tube cuff.
Results: The test group exhibited significantly lower systolic and diastolic blood pressure, as well as heart rate, compared to the control group within 5 minutes after extubation (p < 0.0001 for all measures). Additionally, postoperative sore throat was notably less severe in the test group, with a significant reduction in its incidence (p < 0.0001).
Conclusion: This study demonstrates the effectiveness of EMLA cream in promoting cardiovascular stability and reducing postoperative discomfort, offering clear advantages over lignocaine gel in improving patient outcomes.
References
[2] Peng F, Wang M, Yang H, et al. Efficacy of intracuff lidocaine in reducing coughing on tube: a systematic review and meta-analysis. J Int Med Res 2020;48(2):300060520901872.
[3] Sitzman BT, Rich GF, Rockwell JJ, et al Local anesthetic administration for awake direct laryngoscopy. Are glossopharyngeal nerve blocks superior? Anesthesiology 1997;86:34-40.
[4] Stanley TH, Loeser EA. Minimizing sore throat. Anesthesiology 1979;51(5):488-9.
[5] Jensen PJ, Hommelgaard P, Sondergaard P. Sore throat after operation: influence of tracheal intubation, intracuff pressure and type of cuff. Br J Anaesth 1982;54:453-7.
[6] Yu J, Ren L, Min S, et al. Nebulized pharmacological agents for preventing postoperative sore throat: a systematic review and network meta-analysis. PLoS One 2020;15:e0237174
[7] Agarwal A, Nath SS, Goswami D, et al. An evaluation of the efficacy of aspirin and benzydamine hydrochloride gargle for attenuating postoperative sore throat: a prospective, randomized, single-blind study. Anesth Analg 2006;103:1001-3.
[8] Vickers ER, Marzbani N, Gerzina TM, et al. Pharmacokinetics of EMLA cream 5% application to oral mucosa. Anesth Prog 1997 Winter;44(1):32-7.
[9] Lv L, Yan L, Liu X, et al. Effectiveness of lidocaine/prilocaine cream on cardiovascular reactions from endotracheal intubation and cough events during recovery period of older patients under general anesthesia: prospective, randomized placebo-controlled study. BMC Geriatr 2020;20(1):157.
[10] Soltani HA, Aghadavoudi O. The effect of different lidocaine application methods on postoperative cough and sore throat. J Clin Anesth 2002;14(1):15-8.
[11] Larijani GE, Cypel D, Gratz I, et al. The efficacy and safety of EMLA cream for awake fiberoptic endotracheal intubation. Anesth Analg 2000;91:1024-6.
[12] Sohmer B, Bryson GL, Bencze S, et al. EMLA cream is an effective topical anesthetic for bronchoscopy. Can Respir J 2004;11:587-8.
[13] Yu H, Chu Q, Liu J, et al. EMLA® cream coated on endotracheal tube with or without epidural lidocaine reduces isoflurane requirement during general anesthesia. Front Med 2012;6(3):302-6.
[14] Mecca RS. Postoperative recovery. In: Barash PG, Cullen BF, Stoelting RF, eds. Clinical Anaesthesia Philadelphia, PA: Lippincott-Raven 1997:1279-303.
[15] Chinachoti T, Pojai S, Sooksri N, et al. Risk factors of post-operative sore throat and hoarseness. J Med Assoc Thai 2017;100:463-8.
[16] McHardy F, Chung F. Postoperative sore throat: cause, prevention and treatment. Anaesthesia 1999;54:444-53.
[17] Murugaiyan A, Sahoo AK, Rao PB, et al. Effect of 5% EMLA cream on postoperative sore throat in adults following general endotracheal anesthesia: a randomized placebo-controlled study. Anesth Analg 2023;136(2):338-45.
[18] Scuderi PE. Postoperative sore throat: more answers than questions. Anesth Analg 2010;111:831-2.
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Dr. Sanjitha Banu A.R.
Department of Anaesthesiology, Karpaga Vinayaga Institute of Medical Science and Research Centre, Chengalpattu, India.
Dr. Nivedhitha R.
Assistant Professor, Department of Anaesthesiology, Dhanalakshmi Srinivasan Medical College & Hospital, Perambalur, Tamil Nadu, India,
Dr. Polillan G.R.
Senior Resident, Department of Pharmacology, Dhanalakshmi Srinivasan Medical College & Hospital, Perambalur, Tamil Nadu, India