Skip to main content
Log in

2.5% EMLA Versus 2% Lignocaine with Adrenaline Injection in Small Oral Mucosal Biopsies: A Parallel Group Randomized Controlled Trial

Journal of Maxillofacial and Oral Surgery Aims and scope Submit manuscript

Cite this article

Abstract

Trial Design

The study was designed as an open label randomized comparative parallel group design with a 1:1 allocation ratio.

Methods

All consecutive patients reporting for small biopsies (incisional or excisional) who gave written informed consent were included in the study between October 2018 and October 2019. They were randomized into two groups, Group A and Group B both receiving intervention in the form of 2.5% EMLA cream and 2% Lignocaine with 1:80,000 Adrenaline injection respectively, to anaesthetise tissue for small mucosal biopsies in the oral cavity.

Results

EMLA was found to be as effective as lignocaine infiltration with a completely painless application and higher satisfaction for overall comfort during procedure. The duration required to achieve anaesthesia was however more. A particular subgroup of pathology was found to be completely resistant to anaesthesia by EMLA.

Conclusion

We recommend the use of EMLA as a sole anaesthetic in small mucosal biopsies and shavings in all patients. We suggest it as a higher and first line recommendation for anaesthesia in needle phobic patients and children.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Availability of Data and Material

Will be provided on request.

References

  1. Armfield JM, Milgrom P, Armfield J (2011) A clinician guide to patients afraid of dental injections and numbness. SAAD Dig 27:33–39

    PubMed  Google Scholar 

  2. Taddio A, Soin HK, Schuh S, Koren G, Scolnik D (2005) Liposomal lidocaine to improve procedural success rates and reduce procedural pain among children: a randomized controlled trial. Can Med Assoc J 172(13):1691–1695. https://doi.org/10.1503/cmaj.045316

    Article  Google Scholar 

  3. Meechan JG (2008) Intraoral topical anesthesia. Periodontol 2000 46(1):56–79. https://doi.org/10.1111/j.1600-0757.2008.00231.x

    Article  PubMed  Google Scholar 

  4. Kincheloe JE, Mealiea WL, Mattison GD, Seib K (1991) Psychophysical measurement on pain perception after administration of a topical anesthetic. Quintessence Int 22(4):311–315

    CAS  PubMed  Google Scholar 

  5. Martin MD, Ramsay DS, Whitney C, Fiset L, Weinstein P (1994) Topical anesthesia: differentiating the pharmacological and psychological contributions to efficacy. Anesth Prog 41(2):40–47

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Vickers ER, Marzbani N, Gerzina TM, McLean C, Punnia-Moorthy A, Mather L (1997) Pharmacokinetics of EMLA cream 5% application to oral mucosa. Anesth Prog 44(1):32–37

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Daneshkazemi A, Abrisham S, Daneshkazemi P, Davoudi A (2016) The efficacy of eutectic mixture of local anesthetics as a topical anesthetic agent used for dental procedures: a brief review. Anesth Essays Res 10(3):383. https://doi.org/10.4103/0259-1162.172342

    Article  PubMed  PubMed Central  Google Scholar 

  8. Al-Melh MA, Andersson L (2007) Comparison of topical anesthetics (EMLA/Oraqix vs. benzocaine) on pain experienced during palatal needle injection. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol 103(5):16–20. https://doi.org/10.1016/j.tripleo.2006.11.033

    Article  Google Scholar 

  9. Holst A, Evers H (1985) Experimental studies of new topical anaesthetics on the oral mucosa. Swed Dent J 9(5):185–191

    CAS  PubMed  Google Scholar 

  10. Meechan JG (2000) Intra-oral topical anaesthetics: a review. J Dent 28(1):3–14. https://doi.org/10.1016/S0300-5712(99)00041-X

    Article  CAS  PubMed  Google Scholar 

  11. Kargar R, Aghazadeh-Nainie A, Khoddami-Vishteh HR (2016) Comparison of the effects of lidocaine prilocaine cream (EMLA) and lidocaine injection on reduction of perineal pain during perineum repair in normal vaginal delivery. J Fam Reprod Health 10(1):21–26

    Google Scholar 

  12. vd Berg GM, Lillieborg S, Stolz E (1992) Lidocaine/prilocaine cream (EMLA(R)) versus infiltration anaesthesia: a comparison of the analgesic efficacy for punch biopsy and electrocoagulation of genital warts in men. Genitourin Med 68(3):162–165. https://doi.org/10.1136/sti.68.3.162

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Franz-Montan M et al (2015) Liposomal lidocaine gel for topical use at the oral mucosa: characterization, in vitro assays and in vivo anesthetic efficacy in humans. J Liposome Res 25(1):11–19. https://doi.org/10.3109/08982104.2014.911315

    Article  CAS  PubMed  Google Scholar 

  14. “(No Title).” [Online]. Available: https://www.accessdata.fda.gov/drugsatfda_docs/label/2000/19941s11lbl.pdf. Accessed 07 Feb 2020

  15. Primosch RE, Rolland-Asensi G (2001) Comparison of topical EMLA 5% oral adhesive to benzocaine 20% on the pain experienced during palatal anesthetic infiltration in children. Pediatr Dent 23(1):11–14

    CAS  PubMed  Google Scholar 

  16. McMillan AS, Walshaw D, Meechan JG (2000) The efficacy of Emla® and 5% lignocaine gel for anaesthesia of human gingival mucosa. Br J Oral Maxillofac Surg 38(1):58–61. https://doi.org/10.1054/bjom.1999.0143

    Article  CAS  PubMed  Google Scholar 

  17. Tadicherla S, Berman B (2006) Percutaneous dermal drug delivery for local pain control. Ther Clin Risk Manag 2(1):99–113

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Squier CA (1991) The permeability of oral mucosa. Crit Rev Oral Biol Med 2(1):13–32. https://doi.org/10.1177/10454411910020010301

    Article  CAS  PubMed  Google Scholar 

  19. Lee D et al (2014) Expression of fatty acid binding protein 4 is involved in the cell growth of oral squamous cell carcinoma. Oncol Rep 31(3):1116–1120. https://doi.org/10.3892/or.2014.2975

    Article  CAS  PubMed  Google Scholar 

  20. Elias PM, Brown BE, Ziboh VA (1980) The permeability barrier in essential fatty acid deficiency: evidence for a direct role for linoleic acid in barrier function. J Investig Dermatol 74(4):230–233. https://doi.org/10.1111/1523-1747.ep12541775

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Shruti Khatana.

Ethics declarations

Conflict of interest

None declared.

Consent to Participate

Taken from all participants.

Consent for Publication

Taken from all participants.

Code Availability

Not applicable.

Ethics Approval

Approved by Institutional Ethical Committee.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

CTRI Registration Number: CTRI/2019/01/017102.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chaudhry, K., Khatana, S., Kaur, A. et al. 2.5% EMLA Versus 2% Lignocaine with Adrenaline Injection in Small Oral Mucosal Biopsies: A Parallel Group Randomized Controlled Trial. J. Maxillofac. Oral Surg. 20, 619–627 (2021). https://doi.org/10.1007/s12663-020-01363-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12663-020-01363-6

Keywords

Navigation