An Anaesthetic Lidocaine/Prilocaine Cream (Emla) for Epicutaneous Application Tested for Cutting Split Skin Grafts

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Abstract
A 5% eutectic mixture of the two local anaesthetics lidocaine and prilocaine (EMLA, Astra Läkemedel AB) has been tested for application to the skin in the removal of split skin grafts. EMLA is an oil-in-water emulsion cream, containing 50 mg of active substances per ml (25 mg lidocaine, 25 mg prilocaine). The cream has been used on the donor sites of 146 patients and was applied a minimum of 1 h 30 min before surgery. 123 patients (84.3%) experienced adequate analgesia, feeling only the pressure of the dermatome or slight pain without objection to the skin graft being cut. 20 patients (13.7%) described the pain as being moderate, but the operation could be completed without further local or general anaesthesia. Three patients (2.0%) needed additional anaesthesia. Six patients complained of slight transient irritation immediately after application. After removal of the cream, erythema was present in 42 patients, pallor in 62 and oedema in 14. The concentrations of lidocaine and prilocaine in the blood were measured in 106 patients and did not exceed 1100 ng ml−1 for lidocaine and 200 ng ml−1 for prilocaine. There were no systemic side-effects.