ABSTRACT
Background Subcutaneous lidocaine injection and topical EMLA cream are both used to control lumbar puncture (LP) pain; however, local analgesia usage is not standardized. Methods We conducted a prospective, single-blinded, randomized-controlled crossover trial comparing the two modalities in reducing LP pain. Pediatric patients requiring serial LPs were randomly assigned to receive EMLA cream or lidocaine injection prior to LP. On the subsequent LP, analgesia was defaulted to the other agent. Pain was assessed using the Wong-Baker FACES Pain Rating Scale pre-procedure: 30 to 60 minutes post-LP, and 24 hours post-procedure. Results Ten patients were included in the analysis (median age: 5.5 years). Pain ratings at 1 and 24 hours post-LP did not differ between the two strategies ( p = 0.79). No adverse local reactions were reported for either agent. Conclusion Accordingly, both lidocaine and EMLA cream provided effective LP pain control.
ABSTRACT
A 38-year-old woman was found to have a large placental chorioangioma. The fetus was studied using ultrasound. The pregnancy became complicated by hydrops fetalis, polyhydramnios, and abruptio placenta. The infant delivered at 29 weeks' gestational age. The neonatal course was complicated by nonimmune hydrops fetalis, respiratory distress syndrome, anemia, pulmonary hemorrhage, intraventricular hemorrhage, necrotizing enterocolitis, and bronchopulmonary dysplasia. The infant was discharged home with breastfeeding and off oxygen at 50 days of life. This case represents the multidisciplinary approach to the pregnancy complicated by a large placental chorioangioma and the resulting premature neonate with nonimmune hydrops fetalis.
