The use of EMLA cream reduces the pain of skin puncture associated with caudal block in children

BACKGROUND: Caudal block is a popular regional anesthesia in children undergoing infraumbilical surgeries including inguinal hernia repair and orchiopexy. We evaluated the efficacy of eutectic mixture of local anesthetic (EMLA) cream for reducing needle insertion pain during caudal block in pediatric patients. METHODS: Forty-one children between the ages of 13 months and 5 years undergoing infraumbilical surgery were randomized to receive either topical EMLA or placebo cream over the sacral hiatus one hour before caudal block. All children were assessed with the Multidimensional Assessment Pain Scale (MAPS) at the following time points. T0: arrival at the operation room; T1: just before needle insertion; T2: immediately after needle insertion into the sacral hiatus. The need for sevoflurane inhalation due to procedural pain response was also assessed at the same time as MAPS assessment. RESULTS: MAPS scores were significantly lower in the EMLA group compared with the placebo group at T2 (P = 0.001). Moreover, need for sevoflurane inhalation due to procedural pain response was significantly lower in the EMLA group compared with the control group at T2 (P < 0.001). CONCLUSIONS: We suggest that pretreatment with EMLA cream over the sacral hiatus before caudal block has significant advantages in alleviating procedure pain during caudal block in children.