***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: We have evaluated the anaesthetic effect of tetracaine gel 1 g , applied for 45 min , compared with EMLA cream 2 g , applied for 60 min , in a r and omized , double-blind study in 60 children aged 3 - 15 yr .  Venous cannulation was performed 15 min after removal of the EMLA cream ( n = 20 ) and tetracaine gel ( n = 20 ) . Cannulation was performed up to 215 min after removal of the tetracaine gel in another 20 patients . Significantly lower pain scores were recorded by the children treated with tetracaine gel compared with EMLA cream ( P < 0.02 ) . Forty to 45 % of children in the tetracaine groups reported no pain compared with only 10 % in the EMLA group . Only minor adverse effects were observed . We conclude that tetracaine gel provided effective , rapid , long-lasting and safe local anaesthesia , and was significantly better than EMLA cream in reducing  pain during venous cannulation in children using the recommended application periods for both formulations OBJECTIVES Children view needle sticks as the worst source of pain and fear in the hospital setting . In an effort to minimize the pain of needle sticks , the use of eutectic mixture of lidocaine and prilocaine ( EMLA ) has become st and ard practice in many children 's hospitals . Unfortunately , EMLA requires at least 60 minutes to be fully effective and reportedly may cause vasoconstriction , leading to difficult vein cannulation . A newly available local anesthetic ( ELA-Max ) may require less time and cause less vasoconstriction . The purpose of this r and omized crossover study was to investigate the anesthetic equivalence of EMLA and ELA-Max . METHODS Thirty well children ( 14 girls and 16 boys ) who were between the ages of 7 and 13 years volunteered to have EMLA  applied to the dorsal aspect of 1 h and for 60 minutes and ELA-Max applied to the other h and for 30 minutes . Right and left h and s were r and omized to treatment type and order of intravenous ( IV ) insertion . Clinical Research Center nurses , blind to the anesthetic r and omization , attempted to insert a 22-gauge Teflon IV catheter into a vein in each h and . The children rated pain during IV insertion on the Oucher scale , and the nurse rated the difficulty of the insertion . RESULTS There was no significant difference in pain ratings for h and s that were treated with EMLA ( mean : 20.5 ) or with ELA-Max ( mean : 24 ) , and there was no difference for the difficulty of vein cannulation .  Children 's preprocedure state anxiety was positively associated with pain ratings . CONCLUSIONS ELA-Max , applied for 30 minutes before IV cannulation , has an anesthetic effectiveness similar to EMLA applied for 60 minutes . Some children rated IV insertion pain fairly high for both h and s ( eg , 60 on a 0- to 100-point scale ) despite anesthetic treatment . Preprocedural anxiety may affect the perception and /or rating of pain . There were no differences between h and s that were treated with EMLA or with ELA-Max for success of IV insertion background . Liposomes are microscopic phospholipid vessels that have been utilized to extend the action of topical medications . Previous studies have demonstrated that liposomal vehicles can prolong the action of a variety of medications , including antifungals , anesthetics , interferon , and antineoplastic agents . objective . The purpose of this study was to examine the degree and duration of anesthesia produced by lidocaine in a liposomal vehicle compared with lidocaine in a nonliposomal vehicle and compared with EMLA . The topical preparations in this study were allowed to contact the skin for a 30‐minute period prior to evaluation of anesthetic effectiveness . Unoccluded and Tegaderm‐occluded topical preparations were evaluated in two separate arms of the study . material s and methods . Thirteen healthy volunteers ( three male , 10 female ) were recruited for the nonocclusion arm of the study . Six healthy volunteers ( two male , four female ) were recruited for the occlusion arm of the study . Subjects with a history of allergy to lidocaine , a history of seizures , cardiac or respiratory difficulty , pregnant patients , and patients less than 18 years old were excluded . Written informed consent was obtained from all patients prior to testing . The volar forearms of the volunteers were swabbed with isopropyl alcohol and allowed to dry . A template was then utilized to mark 2 × 2‐cm squares with a skin marker on both volar forearms . In total , nine squares corresponding to nine test areas were marked . The nine test preparations were applied to the test areas in a double‐blinded fashion using a clean swab stick . The test preparations were then allowed to remain on the skin for 30 minutes in either occluded or nonoccluded form depending upon the arm of the study . Following the 30‐minute application period , the test preparations were wiped off with clean gauze . Testing for anesthesia was performed by following a previously published method utilizing gentle pinpricks . A new pinprick apparatus was used for each patient . Pinprick testing was performed at 0 , 15 , 30 , 60 , and 90 minutes following the end of the 30‐minute application period . Patients ' responses to the pinprick were recorded in a binary fashion , as being either : 1 ) totally painless or 0 ) painfully sharp to any degree . Ten applications of the pinprick were applied r and omly across each 2 × 2‐cm test area . The number of painless applications of the pinprick out of a total of 10 applications of the pinprick was then recorded for each test area at every particular test time . In total , nine test preparations were evaluated . Analysis of the data was performed by a PhD statistical faculty consultant from the UCLA Mathematics Department . results . Liposomal lidocaine preparations evidence d longer duration s of anesthesia than lidocaine preparations in nonliposomal vehicles . Five percent liposomal lidocaine preparations were statistically equivalent to EMLA in anesthetic effectiveness . conclusion . Five percent liposomal lidocaine is an effective alternative topical agent for use in the attainment of temporary local anesthesia of the skin A r and omized double-blind study was conducted in 83 women scheduled for elective caesarean section to determine the efficacy of EMLA and lignocaine infiltration for epidural insertion . The patients were r and omly allocated to one of three groups : Group A ( EM/LIG ) received EMLA and intradermal and subdermal 1 % lignocaine infiltration , Group B ( EM/SAL ) EMLA and saline while Group C ( PL/LIG ) received placebo cream and 1 % lignocaine . Assessment s using a 100 mm pain score were performed on skin infiltration and after subsequent insertion of a 16 gauge Tuohy needle into the supraspinous ligament . Skin changes under the applied cream and nursing rating of patients ’ response were also noted . Statistical analyses were performed using Kruskal-Wallis and Fisher 's Exact Tests . Groups were comparable for age , weight , parity and EMLA application time ( interquartile range 105 - 150 minutes ) There were significantly higher pain scores for skin infiltration in Group C ( PL/LIG ) ( P<0.01 ) and for epidural needle insertion in Group B ( EM/SAL ) ( P<0.05 ) . We concluded that in this patient population , the application of EMLA cream for at least 90 minutes plus 1 % lignocaine infiltration optimized patient comfort for epidural insertion Background The eutectic mixture of local anaesthetics ( EMLA ) provides effective topical anaesthesia after a minimum of 60 to 90 mm application . Since liposome-encapsulated tetracaine ( LET ) can provide rapid dermal penetration , the goal of this study was to compare the local anaesthetic effects of EMLA and LET in human volunteers after 60 mm application . Methods After obtaining institutional approval and informed consent , healthy volunteers were recruited in a double blind , crossover , r and omized trial . The study creams ( 0.5 ml EMLA and 0.5 ml LET 5 % ) were applied r and omly to opposite arms for 60 min . The discomfort of iv cathetenzation was assessed using a visual analogue pain score ( VAS ) . Cutaneous side effects of the creams were recorded . Results Sixty-one subjects were studied . Twenty-one were excluded because of technical difficulties . Forty subjects completed the study and were included in the data analysis . The mean ( ±SD ) VAS was lower for LET than for EMLA ( 10.9 ± 9.0 mm vs 22.7 ± 17.1 mm , P < 0.001 ) . Erythema secondary to vasodilatation occurred more frequent in the LET group than in the EMLA group ( 33 vs 3 . P < 0.001 ) . One subject with a history of atopy developed a rash at the LET application site . Conclusion Liposome-encapsulated tetracaine can provide a more effective topical anaesthesia than EMLA for intravenous catheterization after 60 min application . Clinical evaluations are necessary to determine the efficacy and safety of LET in providing topical anaesthesia for vanous invasive percutaneous procedures in other patient population s . RésuméObjectifLe mélange eutectique d’anesthésique local ( EMLA ) appliqué pendant 60 à 90 minutes procure une anesthésie topique efficace . On sait que tétracaïne encapsulée dans les liposomes ( LET ) pénètre le derme rapidement . Cette étude a été entreprise pour comparer les effets anesthésiques locaux de l’EMLA et du LET chez des volontaires humains après 60 mm d’application . MéthodesAprès obtention de l’approbation des instances appropriées et du consentement éclairé , des volontaires ont été recrutés dans une étude aléatoire croisée à double insu . Les crèmes ( EMLA 0.5 ml et LET 5 % 0,5 ml ) ont été appliquées aléatoirement sur des bras opposés pendant 60 min . L’inconfort de la canulation veineuse a été évalué sur une échelle visuelle analogique ( ÉVA ) . Les effets secondaires ont été notés . RésultatsSoixante et un sujets ont participé à l’étude do nt vingt et un ont été rejetés à cause de problèmes techniques . Quarante sujets ont complété l’étude et ont été conservés pour l’analyse des données . L’ÉVA moyenne ( ±ÉT ) du LET était inférieure à celle de l’EMLA ( 10.9 ± 9.0 mm vs 22,7 ± 17.1 . P < 0,001 ) . L’érythème secondaire à la vasodilatation était plus fréquent dans le groupe LET que dans le groupe EMLA ( 33 vs 3 , P < 0.001 ) . Un des sujets considéré comine atopique a présenté de l’érythème au site d’application du LET . Conclusion La tétracaïne encapsulée dans les liposomes peut procurer une anesthésie topique plus efficace que l’EMLA pour la canulation veineuse après 60 min d’application . Des évaluations cliniques sont nécessaires pour déterminer l’efficacité et l’innocuité du LET pour l’anesthésie topique pendant des manipulations percutanées diverses chez d’autres groupes de patients In a double-blind , double-dummy study , the efficacy of topical 5 % EMLA cream was compared with that of lignocaine infiltration in alleviating the  pain of arterial cannulation . Forty unpremedicated adults were allocated r and omly to four groups to receive EMLA cream alone , EMLA and 0.9 % saline infiltration , EMLA and 1 % lignocaine infiltration or placebo cream and 1 % lignocaine infiltration . Following arterial cannulation , pain was assessed by the patient using a visual analogue score and by an independent observer using a four-category verbal rating score . Significantly lower pain scores were observed in all patients receiving EMLA compared with those receiving placebo cream and lignocaine infiltration by both patient ( P less than 0.01 ) and observer ( P less than 0.001 ) assessment s. There were no significant differences between the three EMLA groups In this r and omized , double-blind study , we have compared the ability of 5 % liposome-encapsulated tetracaine ( amethocaine ) ( LET ) vs 5 % eutectic mixture of local anaesthetics ( EMLA ) to produce local anaesthesia of intact skin in 40 healthy volunteers . Volunteers had both preparations applied to their forearms under an occlusive dressing for 1 h. Superficial anaesthesia was measured by a total of nine 1-mm pinpricks on each arm . Deeper anaesthesia was assessed by single insertion of a sterile 22-gauge needle to a depth of 3 mm and pain was reported on a visual analogue scale ( VAS ) . If the volunteer perceived greater than four of the 1-mm pinpricks , the 3-mm insertion was not performed . Results showed that the number of pinpricks perceived was significantly less ( P < 0.01 ) for LET ( median 1.0 ; range 0 - 9 ) vs EMLA ( 1. 
    Output:
    
EMLA may be an effective , noninvasive means of analgesia before dermal procedures .
However , we identified 3 topical anesthetics that are at least as efficacious as EMLA : tetracaine , liposome-encapsulated tetracaine , and liposome-encapsulated lidocaine .
Liposomal lidocaine is commercially available in the United States and offers a more rapid onset and less expensive alternative to EMLA