Dr Adrian R Lloyd-Thomas  Consultant Paediatric Anaesthetist

Local anaesthetic cream

If an injection is to be used, local anaesthetic cream will be applied before the operation.

There are two types of cream:

EMLA Cream: Slower in onset, in my experience it needs to be on for two hours to have a full effect. Almost never produces any adverse skin reaction. Can be left on for as long as required, continues to be effective for up to 45 minutes after removal.

AMETOP Cream: Faster in onset, in my experience is effective in 45-60 min. Commonly results in mild local skin reaction, may produce severe blistering reaction, but with no long term sequelae. Must be removed after 60 minutes, but continues to be effective for up to 45 minutes after removal.

As AMETOP may result in local reactions, I prefer to use EMLA, which will be applied at the time that your child has their last drink before the operation (2 hours in advance). Please tell the nurse and let me know if you think this will be a problem.

The cream will be covered with a clear dressing. If children massage the cream it does not matter, in fact it helps it to work more effectively. If some leaks out, again this does not matter, but don't let your child eat it or rub it into their eyes. If you find that most of the cream has been lost, please ask your nurse for more.

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Please explain to your child that the cream will take the sting away, but they will experience a sensation of pressure when I place the needle.

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