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

Abstract Introduction: Needle prick pain is a distressing event for a patient receiving spinal anaesthesia. A ‘Needle piercing the spine’ might be physically and mentally traumatizing for many patients. 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 practice of giving injections of local anaesthetic or local application of EMLA cream or patch at the site of spinal puncture beforehand for anaesthetizing the skin and subcutaneous tissues. Methods: A prospective cohort study was done. Those enrolled patients were assessed by an expert anesthesiologist, who was not part of the research team, and he prescribed patients either EMLA cream or regular standard lignocaine infiltration anaesthesia and labelled them as Group E and Group L respectively. The pain score was assessed using a Visual Analogue Scale. Result: A total of 64 patients were enrolled in the study- 33 in Group E and 31 in Group L. Both groups had an almost similar number of patients who had a similar extent of surgery. Univariate analysis showed that the mean pain score (VAS) was significantly higher in Group E patients compared to that in Group L, p<0.001. The multivariate analysis had similar findings after controlling confounding factors in multiple regression analysis. Conclusion: Local 2% lignocaine injection achieved significantly more pain reduction during spinal needle insertion compared to the application of an EMLA patch before spinal anaesthesia.