Comfortably numb before epidural or spinal anaesthesia?

There is much to be said for feeling numb. – Douglas Coupland
Background:
The introduction discussed how needle phobic pregnant women had adverse outcomes and attempted to explain why the authors study design focused on reducing discomfort during local anaesthetic infiltration prior to neuroaxial blockade in non-labouring women.  The assumption to be drawn was that reducing pain on local infiltration might negate the patient’s needle phobia.
Methods:
A prospective, randomised, double blinded placebo trial.  Non labouring women were randomly allocated to receive Ametop or placebo cream least 20 minutes prior to LA infiltration. Pain scores were assessed using a 0-10 numeric pain score 20 seconds after infiltration.
Results, Conclusions and Journal Club discussion:
When comparing the two groups there was a 33% reduction in pain score for the group where Ametop cream was applied 20 minutes prior to LA infiltration (P<0.05).  The study did not show whether these patients were needle phobic.  It also did not mention any other outcomes for these patients.  Therefore the only conclusion from the study was that that Ametop cream reduces pain on LA infiltration for non-labouring women.
Summary by Dr Shaun May

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