5% EMLA cream과 20% Benzocaine gel의 도포마취 효능 비교 = Comparative efficacy of 5% EMLA cream and 20% Benzocaine gel during topical anesthesia

다국어 초록 (Multilingual Abstract)

The objective of this study was to determine the effectiveness of topical 5% EMLA cream versus 20% Benzocaine gel in reducing pain from intra oral needle insertion alone as well as injection of anesthetic. The 2 topical anesthetics were tested against each other bilaterally using a randomized, controlled, single blinded, split mouth design. Phase I was conducted to find out the rapidity of onset action of the two agents on anterior/posterior vestibules and anterior/posterior palatal mucosa. Phase II was conducted to evaluate the efficacy of the two topical anaesthetic agents in reducing the pain of intraoral injections. The agents were left in anterior/posterior vestibules and anterior/posterior palatal mucosa for the amount of time recorded in phase I. Subjects recorded pain on a 100-mm modified visual analog scale(VAS). A pulse oximeter was used to recorded the preoperative and postoperative pulse rates. In phase I of the study, two topical agents showed the longer onset of action at anterior part and vestibules than posterior part and palatal mucosa. EMLA cream showed the rapidest onset of action compared to benzocaine gel except on anterior palatal mucosa. In phase II of the study, the VAS grading of the pain for anesthetic administration showed EMLA cream was significantly(P<.05) better in elimination or reducing the pain on the anterior/posterior palatal mucosa. In conclusion, EMLA cream showed the rapidest onset of action compared to benzocaine gel except on anterior palatal mucosa. EMLA cream was found to be superior to Benzocaine gel with regards to pain reduction for anesthetic administration especially on anterior and posterior palatal mucosa.

국문 초록 (Abstract)

이 연구의 목적은 도포마취제로서 5% EMLA cream과 20% Benzocaine gel의 구강 내 주사침 자입 및 마취제 주입시 전 /구치부 전정부와 구개부에서의 작용시간과 동통 감소 효과를 평가하기 위함이다. 두 가지 도포마취제는 양측성 무작위 단일 맹검법 분할 디자인으로 평가되었다. Phase I은 전/구치부 전정부와 구개부에 도포마취제를 도포한 후 각각의 도포마취제의 작용시간을 평가하였다. Phase II는 Phase I에서 측정된 시간을 기초로 각각의 도포마취제를 부위별로 적용하여 주사침 자 입 및 마취제 주입시 동통 감소 효과를 평가하였다. 평가를 위해 100-mm modified visual analog scale(VAS)를 이용하여 주관적인 동통 수치를 기록하였고, 맥박산소측정기(Pulse oximeter)를 사용하여 주사침 자입 및 마취제 주입 전후의 맥박수 를 관찰하여 객관적인 동통 감소 효과를 비교하였다. Phase I 실험결과 두 가지 도포마취제는 전치부가 구치부보다, 구개부가 전정부보다 더 긴 작용시간을 보였다. 전치부 구 개부를 제외한 모든 부위에서 EMLA cream이 Benzocaine gel보다 더 빠른 작용시간을 보였다. Phase II 실험결과 마취제 주입시 부위별 그룹에 따른 VAS Score를 보면 전치부와 구치부 구개부에서 EMLA cream이 Benzocaine보다 동통 감소 효 과에 있어 유의한 차이를 보였다(p<.05). 결론적으로 EMLA cream은 Benzocaine보다 전정부와 구개부 모두에서 빠른 작 용시간과 더 좋은 유지력을 나타냈다. 또한 EMLA cream은 Benzocaine보다 주사침 자입시 전치부 구개부를 제외한 모든 부위에서, 마취제 주입시 전치부와 구치부 구개부에서 Benzocaine에 비해 더 좋은 동통 감소 효과를 보였다.

참고문헌 (Reference)

1 김규식, "치과국소마취학" 지성출판사 1991

2 김희진, "소아에서 EMLA cream을 이용한 도포마취:증례보고" 대한소아치과학회 29 (29): 14-, 2002

3 이재춘, "분사식 주사기를 이용한 소아환자의 국소마취" 대한소아치과학회 28 (28): 633-637, 2001

4 Huskinson EC, "Visual analogue scales. In Melzack R: Pain measurement and assessment" New York Raven, Press 33-37, 1983

5 Pere P, "Topical application of 5% eutectic mixture of lignocaine and prilocaine (EMLA) before removal of arch bars" 30 (30): 153-156, 1992

6 Haasio J, "Topical anaesthesia of gingival mucosa by 5% eutectic mixture of lignocaine and prilocaine or by 10% lignocaine spray" 28 : 99-101, 1990

7 Yaacob H, "The pharmacological effect of xylocaine topical anesthetic-A comparison with a placebo" 6 : 55-57, 1981

8 Meechan JG, "The intra oral use of EMLA cream in children: A clinical investigation" 61 (61): 260-262, 1994

9 Wright GZ, "The effectiveness of infiltration anaesthesia in the mandibular primary molar region" 13 : 278-283, 1991

10 Svensson P, "Svensson H : Efficacy of a topical anaesthetic on pain and unpleasentness during scaling gingival pockets" 41 (41): 35-39, 1994

11 Chung NY, "Severe methemoglobinemia linked to gel-type topical benzocaine use: a case report" 5 : 601-606, 2010

12 Vickers ER, "Pulpal anaesthesia from an application of a eutectic topical anesthetic" 24 (24): 547-551, 1993

13 Krane JE, "Post operative pain management in children" 7 (7): 159-160, 1989

14 Cavino BG, "Pharmacology of local anaesthetic agents" 58 : 701-, 1986

15 Meechan JG, "Oral Surgery for children: 2: Anaesthesia and sedation" Dental Update 206-212, 1993

16 Balicer RD, "Methemoglobinemia caused by topical teething preparation: a case report" 15 (15): 517-520, 2004

17 Raso SM, "Methemoglobinemia and CNS toxicity after topical application of EMLA to a 4-year-old girl with molluscum contagiosum" 23 (23): 592-593, 2006

18 Book A, "Methemoglobin intoxication by prilocaine in EMLA. Accidental intoxication of an infant with scald injuries" 58 (58): 370-374, 2009

19 Huskinson EC, "Measurement of pain" 1127-1131, 1974

20 Ba gesund M, "Lidocaine 20% patch vs lidocaine 5% gel for topical anaesthesia of oral mucosa" 18 (18): 452-460, 2008

21 Campbell AH, "In vivo evaluation of local anaesthetic applied topically" 57 : 2045-2048, 1968

22 Tulga F, "Four types of topical anaesthetic agents: evaluation of clinical effectiveness" 23 (23): 217-220, 1999

23 Holst A, "Experimental studies of new topical anaesthetics on the oral mucosa" 9 : 185-191, 1985

24 Nayak R, "Evaluation of three topical anaesthetic agents against pain: a clinical study" 17 (17): 155-160, 2006

25 Baghdadi DZ, "Evaluation of electronic dental anaesthesia in children" 88 : 418-423, 1999

26 Roghani S, "Evaluating the efficacy of commonly used topical anaesthetics" 21 (21): 197-200, 1999

27 Asarch T, "Efficacy of a computerized local anesthesia device in pediatric dentistry" 21 : 421-424, 1999

28 Parker JF, "EMLA toxicity after application for allergy skin testing" 113 (113): 410-411, 2004

29 Svensson P, "Anesthetic effect of EMLA occluded with orahesive oral bandages an oral mucosa, A placebo controlled study" 39 (39): 79-82, 1992

30 Rosivack RG, "An analysis of the effectiveness of two topical anaesthetics" 37 (37): 290-292, 1990

31 American Dental Association Council On Dental Therapeutics, "Accepted dental therapeutics, Chicago 1984, The American Dental Association sited in Stanley F. Malamed: Hand book of local Anaesthesia, (4th Ed)" Mosby 304-, 1997

32 Juhlin L, "A lidocaine-prilocaine cream for superficial skin surgery and painful lesions" 60 : 544-546, 1980

33 Gill C, "A double-blinded crossover comparison of topical anesthetics" 98 : 213-214, 1979

34 Meechan JG, "A comparison of topical anaesthesia and electronic nerve stimulation for reducing the pain of intra oral injections" 181 (181): 333-335, 1996

35 Meechan JG, "A comparison of 2 topical anaesthetics on the discomfort of intraligamentary injections, A double-blind, split mouth volunteer clinical trial" 87 : 362-365, 1999

36 Vickers ER, "A clinical evaluation of three topical anaesthetic agents" 37 (37): 266-270, 1992