ANESTHETIC POTENTIAL OF LIGNOCAINE / PRILOCAINE CREAM (EMLA) VERSUS LIGNOCAINE INFILTRATION FOR RADIOFREQUENCY ABLATION OF WARTS

The development of topical anesthetics can serve as a better alternative to infiltration anaesthesia for short dermatosurgical procedures. EMLA cream (eutectic mixture of local anesthetics), a topical local anesthetic cream has been shown to penetrate intact skin and provide analgesia of superficial layers. Very few comparative studies are available and therefore data regarding the efficacy and patient acceptability of EMLA over lignocaine infiltration are limited. So, with this background the present prospective study was planned to compare the efficacy, safety and patient acceptability of topical EMLA cream with lignocaine infiltration in patients undergoing radiofrequency ablation of warts from the intact skin of face and neck. A total of 40 volunteer patients with 10 – 15 warts present on face and neck were divided into two groups (group A and B), 20 patients in each group.  Group A received lignocaine infiltration and group B received topical EMLA cream under occlusive dressing. The procedure was executed after 5 min of lignocaine infiltration and 30 min of EMLA application. Pain assessment was done using VAS (visual analogue score). Pain assessment was done both at the time of application and during the procedure. Extent of the pain was also assessed by the patient on a verbal rating. The results of the study show that lignocaine infiltration caused mild to moderate pain except one patient. On the other hand none of the patient experienced any type of pain on application of EMLA cream. The pain assessment during the anesthetics application, lignocaine infiltrated patients revealed significantly higher VAS score in comparison with the EMLA application (3.3 ± 0.865, 0.0; P<0.001). However, during the surgical procedure, EMLA applied patients experienced significantly higher VAS score in comparison with the lignocaine infiltrated patients (P<0.05). The patient acceptability to the EMLA application was found to be more in comparison with lignocaine. Adverse events were mild and comparable in both the groups. In conclusion  EMLA is an efficacious alternative to lignocaine infiltration for radiofrequency ablation of warts and has better patient acceptability.