Elsevier

Urology

Volume 60, Issue 1, July 2002, Pages 135-137
Urology

Adult urology
Use of EMLA cream with vasectomy

https://doi.org/10.1016/S0090-4295(02)01632-1Get rights and content

Abstract

Objectives. To determine whether the application of a eutectic mixture of anesthetic cream (EMLA cream) can decrease the pain of lidocaine injection during vasectomy.

Methods. A double-blind, prospective study was performed in which each patient acted as his own control. One hour before a double-incision vasectomy, EMLA cream was applied to one side of the scrotum and a white lanolin hand cream to the other side. A double-incision vasectomy was performed, and each patient was asked to rate the pain associated with each side of the procedure.

Results. Eighty-nine patients agreed to the study; 61 patients thought the EMLA cream decreased the pain of the vasectomy, 16 preferred the lanolin hand cream, and 3 said there was no difference. These results were significant at the 0.0001 level using the Student t test.

Conclusions. EMLA cream significantly decreases the pain associated with lidocaine injections given as local anesthesia for vasectomy.

Section snippets

Material and methods

Ninety-three men were counseled between February and October 1998 regarding vasectomy and informed consent was obtained. The study protocol was shared with each couple, and 89 men agreed to participate. Each study patient was asked to report to the clinic 1 hour before the planned surgery. The adequacy of his scrotal shave was confirmed, and each cream was applied to the ventral surface of the scrotum, with care taken not to mix the creams across the median raphe. The patient was familiarized

Results

Figure 1 demonstrates the visual analogue scores the 89 patients recorded for the hemiscrotum pretreated with EMLA. Twenty-five patients had no pain with the needle injections of lidocaine and 4 patients recorded a visual analogue score of 5.

Figure 2 demonstrates the visual analogue score the 89 patients recorded for the hemiscrotum pretreated with placebo cream. Four patients recorded a 0 score and 7 patients recorded a 5.

Figure 3 demonstrates the patient preferences for EMLA and placebo

Comment

Vasectomy is the single least invasive and most cost-effective surgical method of birth control known.6 Tubal ligation is far more invasive because general or spinal anesthesia is needed. Tubal complication rates are significantly higher than vasectomy complication rates.7 Despite these factors, only 12% of American men between the ages of 25 and 39 years get a vasectomy.8 The absolute number of American men seeking vasectomy has not increased between 1991 and 1995,9 despite inducements

Acknowledgements

To Gary M. Stack who performed 35 of the vasectomies.

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    Lidocaine or bupivacaine without epinephrine are typically the local anesthetic agent of choice, and are injected using a small needle (eg, 25 gauge or smaller) to reduce patient discomfort. Some clinicians apply an anesthetic cream to the skin before the needle stick, although it is unclear whether this significantly decreases pain.7,8 Vasectomy is performed in 2 distinct steps: delivering and exposing the vas deferens out of the scrotum (vas isolation), and occluding the vas.

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