Efficacy of EMLA Cream Assisted Loco-sedation for Office-based Andrology Procedures

Last updated: February 2, 2024
Sponsor: University of Manitoba
Overall Status: Active - Recruiting

Phase

3

Condition

Anesthesia

Treatment

Eutectic mixture of local anesthetics (EMLA; Astra Pharmaceutical Products Inc., Westborough, MA)

Control cream

Clinical Study ID

NCT06242977
HS25862 (H2023:047)
  • Ages 18-65
  • Male
  • Accepts Healthy Volunteers

Study Summary

Scrotal, urologic surgery has traditionally been conducted in the hospital setting, typically with the use of sedation, spinal anesthesia or general anesthesia. There has been a recent push to move certain scrotal urologic surgeries out of the hospital operating room into a ambulatory, outpatient basis with recent literature demonstrating this in many centers. The use of local anesthesia alone poses numerous benefits. The investigators wish to compare patients who are undergoing invasive scrotal surgery under local anesthetic to those who additionally have a topical anesthetic cream (EMLA) applied to the scrotum to determine if this further increases patient tolerability of these procedures.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • Adult patients undergoing hydrocelectomy, spermatocelectomy, epididymectomy,testicular biopsy, scrotal lesion or cyst excision under local anesthesia alone wereincluded.

Exclusion

Exclusion Criteria:

  • Patients were excluded if their procedure was to be performed with sedatives (e.g.,inhaled nitrous oxide gas, oral, or IV sedation) or did not provide consent to berandomized

Study Design

Total Participants: 72
Treatment Group(s): 2
Primary Treatment: Eutectic mixture of local anesthetics (EMLA; Astra Pharmaceutical Products Inc., Westborough, MA)
Phase: 3
Study Start date:
January 25, 2024
Estimated Completion Date:
August 30, 2024

Study Description

The current standard of care for patients undergoing the majority of urologic procedures is to administer general or spinal anesthesia. The use of general or spinal anesthesia can lead to several complications, long wait times, higher costs associated with the operating. While office-based surgical procedures under local anesthesia can have additional benefits aside from avoiding adverse effects of spinal or general anesthesia, such as ability to communicate, improved convenience, and absence of extended post-op recovery. In one particular study, patients who were surveyed were overwhelmingly satisfied with office-based procedures, and often perceived office-based procedures as less invasive and safer. Urologic care has much to gain from expanding the use of procedures performed under local anesthetic in an ambulatory setting to address the above problems.

Although local anesthetic can be quite effective, needle phobia and negative experiences associated with it can be a common experience. In addition to the fear associated with injection, the traditional local anesthetic injection can also be associated with pain and trauma to the infiltrated site. EMLA (Eutectic Mixture of Local Anesthetic) is a topic anesthetic cream that has in various office based urology procedures. Its use and potential benefits has been seen in a few studies for use in no-scalpel vasectomy, circumcision, metatomy, and more. However its use in more involved/invasive andrology and male-infertility procedures such as hydrocelectomy, penile plications, and others remain poorly studied thus far. Anecdotally, use of EMLA cream as an adjunct to our local anesthetic protocol demonstrated good efficacy in pain control and patient tolerability.

As such, the investigators wish to perform a prospective randomized controlled study at the Manitoba Men's Health Clinic to assess whether or not the use of EMLA cream and local anesthetic nerve block is associated with improved pain tolerance than local anesthetic alone. If our hypothesis provides true, further implementation of EMLA cream in office based andrology and male-infertility procedures may provide better pain control and overall experience for patients.

Connect with a study center

  • Men's Health Clinic Manitoba

    Winnipeg, Manitoba R3K 1M3
    Canada

    Active - Recruiting

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