EMLA anaesthetic cream for sharp leg ulcer debridement: a review of the clinical evidence for analgesic efficacy and tolerability

Sharp debridement is a fast method of achieving a clean leg ulcer, which pr omotes healing and enables skin grafting. EMLA (R) cream is the only topi c al anaesthetic for which there is clinical evidence of analgesic efficacy f or debridement, Thirteen clinical investigations of EMLA are reviewed. Four double-blind studies and one open randomised controlled study show that EM LA applied to the ulcer for 30-45 min under occlusion significantly reduces the pain from sharp debridement, decreases the incidence of post-debrideme nt pain and reduces the time needed to achieve a clean ulcer, giving potent ial savings in healthcare costs. Doses of up to 10g EMLA result in plasma l evels of lidocaine and prilocaine well below toxic levels. Repeated treatme nt does not change the bacterial flora of the ulcer and rarely causes sensi tisation. The treatment of pain in leg ulcer patients is important for pati ent satisfaction and for patient-perceived quality of life.