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. 2021 Dec 24;4(2):53-60.
doi: 10.1002/pne2.12070. eCollection 2022 Jun.

Efficacy of topical lidocaine-prilocaine (EMLA®) for management of infant pain during pneumococcal vaccination: A randomized controlled trial

Beatrice Olsson Duse  1 , Ylva Sporrong  2 , Marco Bartocci  3 , Karin Skoglund  4
Affiliations

Efficacy of topical lidocaine-prilocaine (EMLA®) for management of infant pain during pneumococcal vaccination: A randomized controlled trial

Beatrice Olsson Duse et al. Paediatr Neonatal Pain. .

Abstract

Few studies have evaluated whether topical anesthetic cream reduces pain during pneumococcal vaccination. This is crucial, since effective pain management should be evidence-based. Previous studies have shown that topical lidocaine-prilocaine (EMLA®) reduces vaccination-related pain, measured using pain-rating instruments and observation of crying time. This intervention study aimed to compare the efficacy of topical lidocaine-prilocaine cream with that of the standard of care on the expression of pain during the first pneumococcal vaccination administered at age 3 months under the Swedish national vaccination program. A randomized controlled trial included 72 infants receiving their first pneumococcal vaccination (Prevenar 13®). The study showed that topical lidocaine-prilocaine before pneumococcal vaccination significantly reduced infants' expression of pain according to the Face, Legs, Activity, Cry, Consolability (FLACC) score (P = .006) and increased latency to cry (P = .001). There were no statistically significant differences in the total crying time (P = .146) between the groups. Topical lidocaine-prilocaine cream reduced pain expression and increased latency to cry in infants receiving their first pneumococcal vaccine. Systematic efforts are needed to successfully implement the use of topical anesthetic cream and other effective non-pharmacological pain-relieving strategies during infant vaccination procedures.

Keywords: infants; randomized controlled study; topical anesthetic; vaccine‐related pain.

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Figures

FIGURE 1
FIGURE 1
Consort flow diagram for the study ‐ Efficacy of topical lidocaine‐prilocaine (EMLA®) for management of infant pain during pneumococcal vaccination: a randomized controlled trial
FIGURE 2
FIGURE 2
FLACC score pre‐ and post‐vaccination. The figure show infants’ reaction to vaccination according to the FLACC scale. The boxes comprise the interval between Q1 and Q3. The horizontal line inside the box represents the median value. The whiskers stretch to the highest and lowest scores, as long as they lie within 1.5 IQR from the nearest quartile. More extreme observations are illustrated by circles
FIGURE 3
FIGURE 3
Latency to cry and Total crying time. The figure shows the infants’ Latency to cry and Total crying time according to vaccination in both groups. The boxes comprise the interval between Q1 and Q3. The horizontal line inside the box represents the median value. The whiskers stretch to the highest and lowest scores, as long as they lie within 1.5 IQR from the nearest quartile. More extreme observations are illustrated by circles or stars
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