Comparative study of atienuation of needle prick pain of spinal anaesthesia by local infiltration analgesia versus EMLA skin patch

Introduction: Needle prick pain is a distressing event for a pa?ent receiving spinal anaesthesia. A ‘Needle piercing the spine’ might be physically and mentally trauma?zing for many pa?ents. This may lead to unwanted panic and anxiety during the procedure of spinal anaesthesia. To avoid this distressing needle prick pain, many clinicians have resorted to the prac?ce of giving injec?ons of local anaesthe?c or local applica?on of EMLA cream or patch at the site of spinal puncture beforehand for anaesthe?zing the skin and subcutaneous ?ssues. Methods: A prospec?ve cohort study was done. Those enrolled pa?ents were assessed by an expert anesthesiologist, who was not part of the research team, and he prescribed pa?ents either EMLA cream or regular standard lignocaine infiltra?on anaesthesia and labelled them as Group E and Group L respec?vely. The pain score was assessed using a Visual Analogue Scale. Result: A total of 64 pa?ents were enrolled in the study33 in Group E and 31 in Group L. Both groups had an almost similar number of pa?ents who had a similar extent of surgery. Univariate analysis showed that the mean pain score (VAS) was significantly higher in Group E pa?ents compared to that in Group L, p<0.001. The mul?variate analysis had similar findings a?er controlling confounding factors in mul?ple regression analysis. Conclusion: Local 2% lignocaine injec?on achieved significantly more pain reduc?on during spinal needle inser?on compared to the applica?on of an EMLA patch before spinal anaesthesia.

Eficacia analgésica del EMLA en procedimientos transcutáneos. Revisión sistemática / Analgesic efficacy of EMLA in transcutaneous procedures. Systematic review

Los parches de EMLA son frecuentemente utilizados como anestésicos locales durante la realización en procedimientos invasivos. Con el fin de valorar su eficacia y compararla con la de otros analgésicos y anestésicos disponibles, se realizó una revisión sistemática de todos los estudios realizados que cumplieran criterios de inclusión entre los años 1990 y 2019. Población y métodos: la búsqueda bibliográfica de la evidencia disponible fue realizada en las bases de datos de Cochrane Medline y Lilacs. Se incluyeron todos los ECA y revisiones sistemáticas en pacientes menores de 16 años entre los años 1990 y 2019. Resultados: Fueron hallados 31 artículos de los cuales 21 cumplían con los criterios de inclusión. De dichos 21, solamente 8 estudios resultaron de muy buena y excelente calidad metodológica (JADAD). Conclusiones: El EMLA demostró mayor eficacia como analgésico en el 100% de los estudios donde se comparaba respecto del placebo. Sin embargo, no se encontraron diferencias significativas respecto de otros analgésicos farmacológicos y no farmacológicos.(AU)

EMLA patches are commonly used as local anesthetics in minor invasive procedures. To assess efficacy and compare the patches with other available analgesics and anesthetics, a systematic review was conducted evaluated all studies that met the inclusion criteria published between 1990 and 2019. Population and methods: A literature search of the available evidence was conducted in the Cochrane, Medline, and Lilacs databases. All RCTs and systematic reviews in patients younger than 16 years published between 1990 and 2019 were included. Results: 31 articles were identified of which 21 met the inclusion criteria. Of these 21, of only 8 studies the methodology was of very good and excellent quality (JADAD). Conclusions: EMLA better efficacy as an analgesic in 100% of the studies comparing EMLA patches with placebo. However, no significant differences were found when comparing the patches with other pharmacological and non-pharmacological analgesics.(AU)

Eutectic mixture of Prilocaine and Lignocaine (2.5%) versus 5% Lignocaine versus placebo for pain relief in new-borns undergoing venipuncture: a hospital based, double blind randomised case control study

Background: Venipuncture is one of the most common cause of iatrogenic pain in neonates which is equally stressful to the parents as well as to the personnel performing the procedure. Despite an abundance of data that demonstrate the efficacy of local anesthetics for reducing venipuncture pain in neonates their use in day to day practice is not used widely used. Our objective was to evaluate the efficacy of EMLA cream and 5% Lignocaine cream versus placebo for pain relief in newborns undergoing venipuncture.Methods: Present study was a hospital based, double blind randomised, case control study. A 240 eligible new-borns were randomised into EMLA, 5%lignocaine and placebo groups after randomization. The respective creams were applied 1 hour before the procedure and pain scores were assessed using NIPS scoring during venepunture. Data was analysed using SPSS ver. 20.0 statistical package. Student's unpaired t-test and paired t tests was used to compare continuous data, and to compare pain scores one-way ANOVA was used to compare categorical data. A p-value <0.05 was considered statistically significant.Results: Paired t-tests revealed significant lower NIPS scores in EMLA and 5% lignocaine group than the placebo group (p value=0.001).Conclusions: From present study it can be concluded that both EMLA and 5% lignocaine are equally efficacious and cost effective in reducing the pain of venepuncture in neonates.

Efectividad de dos anestésicos tópicos para la colocación de la grapa. Estudio clínico aleatorizado

Objetivos: Valorar la eficacia de la mezcla eutéctica de lidocaína y prilocaína al 4% comparándola con el gel de benzocaína al 20% en el control del dolor generado por la colocación de una grapa para el aislamiento absoluto previo a la realización de un sellante de fisuras y valorar el efecto psicológico placebo del uso del anestésico tópico. Material y métodos: Se llevó a cabo un estudio clínico aleatorizado. La muestra estuvo constituida por 96 primeros molares permanentes con fosas y fisuras profundas y retentivas, pertenecientes a 24 pacientes. Los molares fueron distribuidos aleatoriamente en 3 grupos de estudio, benzocaína 20%, lidocaína y prilocaína al 4%, vaselina y un grupo control. Antes y después de la colocación de la grapa se registró la escala de dolor de caras-revisada y la frecuencia cardíaca. Resultados: La mezcla eutéctica de lidocaína y prilocaína al 4% obtuvo valores significativamente más bajos en la escala de dolor de caras-revisada, seguida de la benzocaína al 20% y la vaselina (p<0,05). La mezcla eutéctica de lidocaína y prilocaína al 4% presentó menor modificación de la frecuencia cardíaca (p<0,05) en relación con los otros grupos, entre los que no se encontró diferencias estadísticamente significativas. Conclusiones: La mezcla eutéctica de lidocaína y prilocaína al 4% demostró mayor efectividad que el gel de benzocaína al 20% en la prevención del dolor generado por la colocación de una grapa. Del mismo modo se confirmó el efecto psicológico placebo de la anestésica tópica.

Recent advances in topical anesthesia

Topical anesthetics act on the peripheral nerves and reduce the sensation of pain at the site of application. In dentistry, they are used to control local pain caused by needling, placement of orthodontic bands, the vomiting reflex, oral mucositis, and rubber-dam clamp placement. Traditional topical anesthetics contain lidocaine or benzocaine as active ingredients and are used in the form of solutions, creams, gels, and sprays. Eutectic mixtures of local anesthesia cream, a mixture of various topical anesthetics, has been reported to be more potent than other anesthetics. Recently, new products with modified ingredients and application methods have been introduced into the market. These products may be used for mild pain during periodontal treatment, such as scaling. Dentists should be aware that topical anesthetics, although rare, might induce allergic reactions or side effects as a result of an overdose. Topical anesthetics are useful aids during dental treatment, as they reduce dental phobia, especially in children, by mitigating discomfort and pain.

The use of EMLA cream reduces the pain of skin puncture associated with caudal block in children / 대한마취과학회지

BACKGROUND: Caudal block is a popular regional anesthesia in children undergoing infraumbilical surgeries including inguinal hernia repair and orchiopexy. We evaluated the efficacy of eutectic mixture of local anesthetic (EMLA) cream for reducing needle insertion pain during caudal block in pediatric patients. METHODS: Forty-one children between the ages of 13 months and 5 years undergoing infraumbilical surgery were randomized to receive either topical EMLA or placebo cream over the sacral hiatus one hour before caudal block. All children were assessed with the Multidimensional Assessment Pain Scale (MAPS) at the following time points. T0: arrival at the operation room; T1: just before needle insertion; T2: immediately after needle insertion into the sacral hiatus. The need for sevoflurane inhalation due to procedural pain response was also assessed at the same time as MAPS assessment. RESULTS: MAPS scores were significantly lower in the EMLA group compared with the placebo group at T2 (P = 0.001). Moreover, need for sevoflurane inhalation due to procedural pain response was significantly lower in the EMLA group compared with the control group at T2 (P < 0.001). CONCLUSIONS: We suggest that pretreatment with EMLA cream over the sacral hiatus before caudal block has significant advantages in alleviating procedure pain during caudal block in children.

Topical EMLA Cream as a Pretreatment for Facial Lacerations

BACKGROUND: Topical anesthetics, such as eutectic mixture of local anesthetics (EMLA) cream, can be applied to reduce pain before minor procedure. This trial evaluated EMLA as pretreatment for facial lacerations and compared pain, discomfort and overall satisfaction. METHODS: This trial included consecutive emergency department patients > or =16 years of age who presented with simple facial lacerations. At triage, lacerations were allotted to either the routine processing group or EMLA pretreatment group according to date of admission. Initially, the emergency department doctors inspected each laceration, which were dressed with saline-soaked gauze. In the pretreatment group, EMLA cream was applied during wound inspection. The plastic surgeon then completed primary closure following the local injection of an anesthetic. After the procedure, all patients were given a questionnaire assessing pain using the 10-point visual analog scale (VAS) ("no pain" to "worst pain"). All questionnaires were collected by the emergency department nurse before discharge. RESULTS: Fifty patients were included in the routine processing group, and fifty patients were included in the EMLA pretreatment group. Median age was 39.9 years, 66% were male, and the average laceration was 2.67 cm in length. The EMLA pretreatment group reported lower pain scores in comparison with the routine processing group (2.4 vs. 4.5 on VAS, P<0.05), and lower discomfort scores during the procedure (2.0 vs. 3.3, P=0.60). Overall satisfaction was significantly higher in the EMLA pretreatment group (7.8 vs. 6.1, P<0.05). CONCLUSIONS: Pretreating facial lacerations with EMLA topical cream aids patients by reducing pain and further enhancing overall satisfaction during laceration treatment.

A comparison of the onset time of complete blockade of the sciatic nerve in the application of ropivacaine and its equal volumes mixture with lidocaine: a double-blind randomized study / 대한마취과학회지

BACKGROUND: The purpose of the current study is to create a new mixture of local anesthetics-one with a short time of block development and short action term (5 ml of 1% lidocaine solution) and another with a longer time of anesthesia development and a long analgetic effect (5 ml of 0.75% ropivacaine)-for use during surgical operations on extremities. The primary end point was the development of the complete sensory block of the sciatic nerve. METHODS: Sixty blocks of sciatic nerve were used in a double-blind randomized research, under ultrasonic guidance, using an electric stimulator with the peripheral nerves. Sixty patients were divided into 3 equal groups. In the first group, a sciatic nerve block was performed with 5 ml of 0.75% ropivacaine solution (37.5 mg); in the second group, 10 ml of 0.75% ropivacaine solution (75 mg) was used and, in the third group, a mixture of 5 ml of 0.75% ropivacaine (as above) and 5 ml of 1% lidocaine solution (50 mg) was used. The assessment of the time required for developing sensory and motor blocks was carried out from the beginning of local anesthetic solution injection in the fascial sheath of the sciatic nerve. RESULTS: Demographic data of patients were identical in the three sample groups. The time required for achieving a complete motor and sensory block was reduced due to the mix of the 1% lidocaine solution with the 0.75% ropivacaine solution. The time required for achieving a complete sensory block in groups treated with 5 and 10 ml ropivacaine was 45 (40-48) and 30 (28-30) min, respectively, in contrast with 12 (10-13) min when the mixture of anesthetics was applied (P 0.05. CONCLUSIONS: The mixture of 5 ml of 1% lidocaine with 5 ml of 0.75% ropivacaine leads to a reduction in the time required for the development of complete sensory and motor blocks of the sciatic nerve, without reducing postoperative analgesia time.

Effects of EMLA Cream in Intradermal Skin Test of Ampicillin Sodium Antibiotics / 기본간호학회지

PURPOSE: The purpose of this study was to identify the effects of EMLA cream (eutectic mixture of local anesthetics, lidocaine and prilocaine) on pain during ampicillin sodium intradermal (ID) skin test, and also to assess skin reaction after the skin test. METHODS: Forty-three nurse-volunteers had skin tests with 0.01ml-0.05ml ampicillin sodium antibiotics. Skin tests were done on each forearm to compare the pain level of the skin test site after application of EMLA cream with the pain level when no EMLA cream was applied. EMLA cream was applied at the ID skin test site with an occlusive dressing for one hour. Pain was evaluated using a visual analogue scale and pain sensation using the short form McGill Pain Questionnaire. The transverse diameter of the wheal and redness was read right after and at 15 minutes after the skin test. The results were compared using independent t-tests. RESULTS: Pain score and sensation with EMLA cream treatment were significantly lower than when EMLA cream was not applied. There was no difference in skin reactions; reading of the skin test was not affected by EMLA cream. CONCLUSIONS: EMLA cream was found to be an effective local anesthetic to relieve the pain of clients having ampicillin sodium antibiotics ID skin tests.

Effects of Topical Anesthetics to Reduce Pain in Preterm Infants During Percutaneous Cental Venous Catheterization (PCVC) / 대한주산의학회잡지

PURPOSE: The purpose of this study is to prove the effects of topical anesthetics (EMLA) to control pain in preterm infants during invasive procedure (percutaneous central venous catheterization, PCVC). METHODS: A total of 18 preterm infants of birth weight <2,000 g and gestational age <36 weeks born at EulJi University Hospital, at Daejeon in 2010 were randomly included in this study. EMLA was applied in nine preterm infants 40 minutes before starting PCVC and placebo was applied in another nine preterm infants. Based on PIPP (preterm infant pain profile), we evaluated their heart rate, oxygen saturation before, 15 seconds during and 30 seconds after procedure. Behavioral responses were also recorded for 2 minutes after procedure. RESULTS: Experimental group showed significantly less behavioral response during procedure (P=0.005) and 2 min after procedure (P=0.001). Also, experimental group showed less increase in heart rate (P=0.033) and reduction of behavioral state (P=0.017). CONCLUSION: Despite limitation of small size in this study, experimental group showed lower pain score compared with placebo control group during catheterization. In neonatal care unit (NICU), we recommend the use of topical anesthetics such as EMLA to control pain during invasive procedures.

Effect of Oral Administration of Acetaminophen and Topical Application of EMLA on Pain during Transrectal Ultrasound-Guided Prostate Biopsy

PURPOSE: Transrectal ultrasound-guided prostate biopsy is the procedure of choice for diagnosing prostate cancer. We compared with pain-relieving effect of acetaminophen, a known drug for enhancing the pain-relieving effect of tramadol, and eutectic mixture of local anesthetics (EMLA), a local anesthetic agent, with that of the conventional periprostatic nerve block method. MATERIALS AND METHODS: This was a prospective, randomized, single-blinded study. A total of 430 patients were randomly assigned to three groups. Group 1 received a periprostatic nerve block with 1% lidocaine, group 2 received acetaminophen 650 mg, and group 3 received EMLA cream for pain control. All patients were given 50 mg of tramadol intravenously 30 minutes before the procedure. At 3 hours after completion of the procedure, the patients were asked to grade their pain on a horizontal visual analogue scale (VAS). The patients were also asked whether they were willing to undergo future biopsy if required. RESULTS: There were no significant differences between the three groups in terms of age, prostate-specific antigen, prostate size, or numbers of biopsy cores. The pain scores for groups 2 and group 3, which were 3.47+/-1.92 and 3.50+/-1.36, respectively, were similar and were significantly lower than that of group 1, which was 5.24+/-2.07. CONCLUSIONS: Acetaminophen and EMLA cream with intravenous injection of tramadol are safe, easy, and effective methods of controlling pain during the procedure. These methods were more effective for pain relief than was the conventional periprostatic nerve block method.

Pain Control for Hydrofluoric Acid Chemical Burn Using EMLA(R) Creams

PURPOSE: Although Hydrofluoric acid(HF) is not a strong acid compared to other hydrogen halides, it is a feared corrosive and is particularly dangerous in higher concentrations. HF burns are characterized by symptoms, often delayed and localized with diluted HF solutions, to include erythema, edema and severe pain. Pain, a well known symptom, is followed by exposure to calcium binding. And, EMLA(R) cream is a topical formulation based upon the eutectic mixture of lidocaine and prilocaine and is used in clinical settings to relieve pain undergoing superficial surgical procedures. The aim of this study is to evaluate effects of EMLA(R) cream, pain-control dressing on the treatment for HF injury wound. METHODS: From June 2007 to June 2008, this study was carried out with 10 patients who had HF partial thickness burns. We were applied topically EMLA(R) cream to injured wound with vaseline gauze and 10% calcium gluconate wet gauze dressings. As a principle, in the emergency treatment, partial or complete removal of the bullae along with copious washing with normal saline was done, depending on the degree of HF invasion of the distal digital extremities. The effect of dressing was investigated by visual analogue pain scale. RESULTS: We therefore reviewed 10 cases of HF- induced pain and pain relief treatment principle. The 10 cases who came to the hospital nearly immediately after the injury healed completely without sequelae and EMLA(R) related complications. CONCLUSION: Proper initial treatment of HF burn is important. If not promptly recognized or properly treated, it produces serious injury. Topical EMLA(R) cream remains a powerful, new advancement for minimizing HF-related pain during dressing procedures. When used appropriately, topical EMLA(R) cream can be a safe and effective alternative to other forms of HF-pain control treatment.

Efficacy of EMLA(R) for Pain Relief during PhotodynamicTherapy in the Treatment of Common Warts / 대한피부과학회지

BACKGROUND: Photodynamic therapy (PDT) in the treatment of warts is known to be a relatively effective and safe cure. However, the pain, which occurs during being exposed to a light source and after its exposure, is being reported to be the most frequent and serious limitation in this therapy. OBJECTIVE: The purpose of this study is to examine whether the level of pain can be lowered, by comparing EMLA(R), which is a topical anesthesia, with placebo, during topical ALA-PDT, and to try to compare the range and characteristics in pain. METHODS: Twenty two patients with common warts were treated with ALA-PDT twice in the interval of 4 weeks, and were divided into two groups by the random distribution table. The distribution was made so that the patients, who used EMLA(R) as the topical anesthesia given at the first visit, could use a placebo at the second visit, and so that the patients who used placebo at the first visit, could use EMLA(R) at the second visit. Thus, a randomized, double-blind, placebo-controlled crossover study was carried out. The pain was evaluated during the treatment, right after the treatment, and one day after the treatment by using Visual Analogue Scale (VAS). Also four different ranges of the pain and its six characteristics were evaluated. RESULTS: Of the 22 patients with common warts who underwent this study. 1 patient, was completely cured after the first visit, and did not participate further in the study. The data of the patients with complete recovery wasn't included in the final statistical analysis. As a result of the evaluation of pain, the mean VAS score that was measured during the treatment, right after the treatment, and one day after the treatment was measured to be a little lower in the case of applying EMLA(R) versus placebo, but a statistically significant difference was not observed. Regarding the degree of pain, regardless of applying EMLA(R), most patients felt painful locally on the surface, and the majority complained of burning and shooting pain. CONCLUSION: Dermatologists tend to routinely apply EMLA(R), prior to a procedure in order to decrease pain. However, as a result of this research, the routine use of EMLA(R) given at PDT is thought to be unreasonable.

Pain reduction at venipuncture in newborn infants: oral glucose solution, EMLA cream(R) and pacifiers / 소아과

PURPOSE: We compared the pain reducing effect of orally administered glucose solution with EMLA cream and pacifiers during venipuncture in newborn infants. METHODS: Fifty newborn infants(30 prematures) were enrolled in this study. We performed these four pain-reducing methods to all infants in serial order. Group A(control) did not receive any treatment; to group B, EMLA cream was applied on the skin for 1 hour; group C(or D) received 10 percent(or 30 percent) glucose solution orally; group E used pacifiers. Symptoms and signs associated with pain at venipuncture were measured with the Premature Infants Pain Profile(PIPP) scale. RESULTS: There was no significant difference in the PIPP scores between preterm and fullterm infants. The mean PIPP scores of groups were A:12.5+/-2.5, B:10.1+/-2.6, C:9.4+/-2.0, D:6.5+/-2.1 and E:8.7+/-2.3; the mean scores of groups B, C, D and E were significantly lower than that of group A(all, P<0.001 except B(P<0.05)), and the mean score of D was significantly lower than those of B, C and E(P<0.001, P<0.005, P<0.05, respectively). The percentages of patients with PIPP scores above 6, which means pain, were A:100 percent, B:82 percent, C:56 percent, D:40 percent and E:70 percent. The percentages of patients with PIPP scores above 12, which means severe pain, were A:72 percent, B:30 percent, C:22 percent, D:0 percent and E:14 percent; that of group D was clearly lowest. CONCLUSION: These results support the use of oral glucose solution, EMLA, and pacifiers for pain reduction as effective intervention at venipuncture in newborn infants. The most effective method was a 30 percent oral glucose solution.

A Case of Allergic Contact Dermatitis Due to EMLA(R) / 대한피부과학회지

EMLA is a eutectic mixture of 2.5% lidocaine and 2.5% prilocaine for topical anesthesia and commonly used to avoid pain in cutaneous surgery or vascular punctures. We describe a 27-year-old female who had lower extremity hair removed by laser treatment after EMLA application and subsequently developed of adverse reactions, including itching, erythema and edema. Patch testing with EMLA showed allergy reaction at day2 and day4.

The Effects of EMLA on Pain Associated with Retrobulbar Injection

A prospective study was undertaken to assess the efficacy of the anesthetic cream EMLA (Eutectic Mixture of Local Anesthetics)in alleviating the pain of retrobulbar injection in patients undergoing cataract surgery.One-hundred forty-three patients who had undergone cataract surgery under local anesthesia in Korea Veterans Hospital from July 1999 to February 2000 were selected randomly into three groups and each of them had no significant difference in their age, sex and underlying conditions.Fifty-seven patients received the EMLA cream, 43 patients received the placebo and the remaining 43 patients received nothing.Among three groups, the EMLA group and the placebo group were double masked.The pain assessed subjectively by the patient was expressed in 11 scales (0-10).And the reactions of the patients to needle insertion, which had been objectively assessed by the one operator, were graded into 4 scales (0-3).No patient experienced serious side effects in each treatment group.In subjective grading, the EMLA group which had been graded as 2.91 +/-1.93 was proven to be more effective in reducing pain than the placebo group (6.2 +/-2.02)and the not-treated group (6.56 +/-1.64).In objective grading, the EMLA group (0.44 +/-0.63)was superior to the placebo group (0.98+/-0.99)and the no treated group (1.4 +/-0.13).In conclusion, local pretreatment using the EMLA cream to alleviate the pain on retrobulbar injection is one of good methods for enhancing the patient cooperation in cataract surgery with reduced anxiety.

Subclavian Catheterization in the Pediatric Patients

PURPOSE: Central venous catheters are used to deliver antibiotics, chemotherapeutic agents, and parenteral nutrition for a extended period of time as well as to draw samples in immunocompromised patients to minimize the discomfort with sampling and the risk of introducing infections. Hickman/Broviac catheters or implantable devices have been used in pediatric patients. This study is aimed to evaluate the safety and clinical efficacy of subclavian catheterization which has advantages of low cost without need of general anesthesia or skillful surgeon. METHODS: Between August 1994 and October 1995, subclavian venous catheters were inserted in 22 patients. The age ranged from 3 months to 17 years (median 9 years 5 months). Patients weight ranged from 5.7kg to 57.0kg (median 27.5kg). Nineteen patients had various malignancies. Arrow multi-lumen/ two-lumen central venous catheters were used. Without general anesthesia, pediatricians inserted the subclavian catheters by blind puncture at bedside after administering 0.035mg/kg of midazolam and 0.05mg/kg of morphine sulfate. Emla cream was applied at the puncture site one hour prior to the procedure. We retrospectively evaluated the patient characteristics and complications associated with catheter placement and maintenance. RESULTS: The median duration of catheter placement was 53 days, with a range of 6 to 175 days. In early series, 2 cases of pneumothorax and a case of hemothorax occured during the catheter insertion. Occlusion and infection of catheters occured in 11 and 6 patients, respectively. Twenty catheters were removed: no need to continue, 7; patient death, 4; inadvertent removal, 4; complete occlusion 3 and 2 cases of catheter-related infections. CONCLUSIONS: Subclavian catheterization is a safe, cost-effective, easy-to-perform technique of providing long-term venous access which can be done by pediatrician at bedside without the risk of general anesthesia.

Effects of EMLA Cream on the Structure of the Rat Tympanic Membrane / 대한이비인후과학회지

BACKGROUND: EMLA cream is a eutectic mixture of lidocaine and prilocaine and has excellent anesthetic effect on tympanic membrane but histologic influence on tympanic membrane is uncertain. OBJECTIVE: To investigate its histologic effects on tympanic membrane. MATERIALS AND METHODS: 18 Sprague-Dawly rats were divided into 6 groups. Each group was treated with application of EMLA cream into external ear canal and then were sacrificed at 4 hours, 24 hours, 3 days, 7 days, and 14 days after application of the agents. RESULTS: 1) Transmission electron microscopy revealed partial loss of epithelial cell at 4 hours after application of the agents. 2) The specimen showed damaged cells in the epidermal layer and partial loss of basement membrane at 24 hours after application of the agents. 3) At 1 week after application of the agents epidermal layer and inner epithelium with connective tissue predominated. Thus the fibrous layer represent only 1/3 of total drum thickness. In the basal layers widened intercellular spaces were noted. 4) At 2 weeks after application of the agents newly formed connective tissue was found at fibrous layer and numerous fibroblasts were noted at inner epithelial layer. but overall histologic changes of the drum were not significant and healing processes was noted. CONCLUSION: EMLA cream has less histopathologic effects on tympanic membrane, and early recovery process occurred.