Split-skin grafting with lidocaine-prilocaine cream: A meta-analysis of efficacy and safety in geriatric versus nongeriatric patients

Although the efficacy and safety of the topical anesthetic EMLA cream (lido caine-prilocaine) have been studied extensively in children and adults, no published studies have focused on geriatric patients (greater than or equal to 65 years of age). The objective of this study was to compare the effica cy and safety of EMLA in geriatric versus nongeriatric adults. A pooled ana lysis was made from original data of six studies of EMLA cream for split-sk in grafting. The studies selected had a sufficient number of geriatric and nongeriatric adults and a uniform, standardized pain stimulus (split-skin g rafting), pain rating (visual analogue scale, verbal rating scale) and adve rse event recording. A total of 182 geriatric patients (82 aged 65 to 74 ye ars; 100 aged 75 to 96 years) and 221 nongeriatric EMLA-treated patients we re evaluated. There was no difference in the efficacy of EMLA between geria tric and nongeriatric adults who underwent similar onset and duration of an esthesia. EMLA cream 1.5 g/10 cm(2) applied for 2 to 5 hours and a similar anesthetic effect in both agr groups. A dose of 3 g/10 cm(2) gave no furthe r benefit. In a geriatric population. EMLA cream provided effective cutaneo us anesthesia for the cutting of split-skin grafts to the same extent as di d infiltrated lidocaine. Adverse event frequency and severity were similar in geriatric and nongeriatric patients. Transient application site pallor, redness, and edema were the most frequent adverse events. Topical anesthesi a with EMLA cream for split-skin grafting is as safe and effective in geria tric as in nongeriatric adults.