PAIN AFTER SUBCUTANEOUS INJECTION OF RECOMBINANT-HUMAN-ERYTHROPOIETIN- DOES EMLA CREAM HELP

Recombinant human erythropoietin (rHuEpo) is used to correct anaemia i n dialysis patients. Subcutaneous administration of rHuEpo may be asso ciated with pain at the injection site. This study assessed the pain o f subcutaneous infiltration of two different preparations of rHuEpo, a lpha and beta, and the value of a local anaesthetic (Emla) cream, in r educing the pain of infiltration. Forty-eight haemodialysis patients w ere enrolled into a double-blind, placebo-controlled, paired-compariso n study. Pain was assessed using a visual analogue scale, a verbal des criptive scale and a direct comparison between paired treatments. Subc utaneous injection of rHuEpo alpha was more painful than rHuEpo beta ( P < 0.001); using placebo cream 42% of patients described the pain of rHuEpo alpha as severe or very severe, whereas none of the patients fo und rHuEpo beta so painful. Application of Emla for at least 2 h prior to injection resulted in a significant reduction in the pain of both preparations, but was unable to reduce the pain of rHuEpo alpha to tha t of rHuEpo beta. Subcutaneous injection of rHuEpo alpha is more painf ul than rHuEpo beta, even after application of Emla. Although the disc omfort of rHuEpo beta is graded as very mild by most adult patients th e use of Emla is associated with a significant reduction in discomfort , which may be of benefit to paediatric patients.