Comparision of the antinociceptive effect of topical EMLA cream with breast feeding, topical EMLA cream with distilled water & topical placebo cream with distilled water, during first DPT vaccination in healthy term infants

Abstractxml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /

Objective: To compare efficacy in pain reduction due to wDPT using  (a) EMLA cream along with breast feeding (EB group) and (b) EMLA cream with oral distilled water (EW group) as compared to placebo cream with oral distilled water (PCW group). Methods: Design: A Randomized, double blind, placebo controlled trial. Setting: The immunization clinic of Department of Pediatrics, xml:namespace prefix = st1 ns = "urn:schemas-microsoft-com:office:smarttags" /LLRM Medical College, Meerut. Participants: Infants less than 3months of age who visited immunization clinic for their 1st DPT vaccination, they were randomized in three groups of 30 each. Outcome measure: The primary outcome variable was the duration of cry after vaccination. Secondary outcome variables were latency of onset of cry and Modified Facial Coding Score.

Results: 30 babies were enrolled in each of 3 groups. Median (IQR) of duration of cry was least 34.6 (24.1-72.2) seconds in EB group, followed by 94.2 (46.1-180) seconds in EW group as compared to 180.0 (180-180) seconds in PCW group (P<0.05).  Mean (95%CI) of latency of cry was significantly more in EB group 2.4 (1.9-2.8) seconds) and EW group 1.9(1.7-2.1) seconds) as compared to babies in PCW 1.5 (1.3-1.6) seconds) (P<0.05) but the difference between EB and EW group was not significant. Modified Facial Coding Score at 1min and 3min was significantly lower in EB group as compared to EW and PCW group(P<0.05).

Conclusions: Topical EMLA application is effective in reducing pain due to DPT vaccination in young infants up to 3 months of age. It has synergistic effect in analgesia when combined with breast feeding during vaccination.