Trick of the Trade: Topical anesthetic cream for cutaneous abscess drainage in children

See also: cheap viagra | cheap cialis | 

Abscess drainage can be painful and time consuming in the ED. Can this article help?

Trick of the Trade: 

Apply a topical anesthetic cream on skin abscesses prior to incision and drainage (I and D).

In this press-released article in American Journal of Emergency Medicine, the authors found that application of a topical 4% lidocaine cream (LMX 4) was associated with spontaneous cutaneous abscess drainage in children.

Study Design:

  • Retrospective chart review of children presented with skin abscess to an urban ED.

  • Excluded are pilonidal abscess, paronychia or abscess involving genitalia.

  • A subset of 300 patients were selected (100 at each of 3 academic sites).

Data collection:

  • The treating physician decided whether a topical anesthetic should be used.

  • The sites used a topical lidocaine cream (LMX 4). The cream is applied on the abscess with an occlusive dressing for 30-40 minutes. They looked at abscess treatment and return visits.


  • 169 children required treatment in the ED.

  • 110 received topical anesthetic (younger, more MRSA, less surrounding cellulitis) and 59 did not.

  • Mean abscess size was not different between the two groups: 3.4 ± 2.4 with topical anesthetic vs 4.0 ± 2.7 cm without topical anesthetic, p = 0.22).

  • 26/110 (24%) abscesses with topical anesthetic spontaneously drained in the ED vs 0/59 (0%) without a topical anesthetic.

  • For the the topical anesthetic group, 26/110 (24%) needed procedural sedation. In contrast, 24/59 (41%) abscess without topical anesthetic needed procedural sedation. (OR 0.45)

  • 22% in the topical anesthetic group returned to the ED (2% needed intervention) versus 34% in the no topical anesthetic group (none needed intervention).

How would this change my practice?

I would consider using topical anesthetic cream prior to abscess drainage. Even though it might still need I and D, I might avoid a procedure sedation.

Study limitation

Because this study was a retrospective study, selection bias may have occurred. Specifically, providers may have preferentially applied topical anesthetic or chosen procedural sedation, based on undocumented characteristics. It was nice to see that mean abscess size was not different between the two groups.


Cassidy-Smith T, Mistry RD, Russo CJ, McCans K, Brown N, Capano-Wehrle LM, Drago LA, Vitale PA, Baumann BM. Topical anesthetic cream is associated with spontaneous cutaneous abscess drainage in children. Amer J Emerg Med. 2010 - in press. PMID: 21129885


Don't fear erectile dysfunction!

Impotence is a curse. At least men that suffer from it believe so that is why they try to avoid any conversations or questions about potency and the maintenance of the sexual intercourse. It gets to the point when they can no longer be frank and open about their issues. They hide away their problems and mainly that creates insecurities and communicative obstacles even between those people that were supposed to be close. How can it be explained? It is very difficult for men to admit they have sexual difficulties while finding themselves in some sexual act with the person they sexually desire. They stray refusing to talk about it. But in reality everything is much simpler than one can imagine. There are plenty of medications that ca fix the problem in one second - well, not one but let's say 30 minute would be enough totally to blank off from the way the situation was.

Erectile dysfunction pills can really turn your sexual life around. They can give you hope and will definitely make you feel good. But one has to remember that it is a pill and every pill has side-effects if taken out o proportion. Erectile dysfunction pills are similar in a way. They can "heal you or kill you" as they say, so you have to be conscious of what you are doing before you start your treatment. Here is a list of side-effects that might be waiting for you around the corner if you take an overdose:

First of all there is back pain. You might be also experiencing dizziness and have a headache. If you feel like having indigestion please inform your doctor about it. Maybe you muscle pain will be your side-effect case or it can also happen that your eye might hurt but don't worry. One call to your doctor will solve it. If you feel pain instead of pleasure during sexual acts you should know that something is wrong. Tell your doctor about it immediately.

As we already said there are plenty of drugs. But cheap cialis is known to give one of the best results. While in action Cialis is unbelievable because it helps men feel strong and sexually active. The drug is meant to help produce an erection and the latter can only be produced when the nervous system sends signals to the brain for releasing chemical messengers within the tissue of the penis. When the blood vessels of the reproductive organ swell it allows blood to penetrate inside the penis and that creates erection for men.

It doesn't take long for this medication to start to work. You can take a pill right before your sexual intercourse and within 30 minutes you will feel like you are a superman full of energy and strengths.

And you don't have to go to the pharmacy to get the pill. You can order it online anytime plus it is always possible to receive a discount. Most websites that deal with medications will gladly offer you a good price just to keep you by their side for longer. Delivery doesn't keep itself waiting for too - you can receive your pills within 24 hours. So don't hesitate to order Cialis now to have a pleasant night as soon as tomorrow!

Add Post To: |









<a href='>Simpy</a>| <br/></span> <br/>

The Hoodia Diet Pill Plan-Three Steps to a Trimmer You

*Look Out for the Dangerous Pharmaceutical Alternatives to Hoodia*

How is it that this new diet pill is outstripping the pharmaceutical alternatives? With hundreds of weight loss purchase cialis to choose from, hoodia is the one that has gained in popularity in a big way. Why has this happened?

The answer is simple: these cialis help you to lose weight faster by suppressing your appetite and they do so safely (unlike the pharmaceutical alternatives).

It doesn't take a genius to figure this out. If you aren't as hungry, you will eat less. If you eat less, you have a much better chance at losing weight. Brilliant, eh?

You see, people would love to be able to lose weight and be healthy without much effort (if only they could get away with it). So they think, "You know, if I can take a weight loss pill that would melt off the pounds (without too much effort, of course) that would be great!"

*Don't Destroy Your Health While Trying to Look Better*

Who in their right mind wouldn't want to feel better and get rid of unwanted weight? Anyone who feels they are over weight would love to get rid of the excess pounds. However, they have a tendency to get hungry...they want to eat. That's what makes appetite suppressants such an attractive alternative, but, if you choose the wrong kind, they can be dangerous.

The only diet pills available before the hoodia diet pill came on the market had a chemical foundation with unwanted side affects. Sure, these pills became very popular within a short time-after all, they promised effortless weight-loss. However, they often came with a heavy list of side effects and most were dumped due to the dangers associated with their use, and some were even banned.

Ahhh, now all pharmaceutical diet pills are safe, right? Not right. There is a lot of money in diet pills, so, to make a long story short, there are still pills being sold containing the same dangerous ingredients as the banned ones, but the names have been changed. Then along came the hoodia diet pill. The great thing about this appetite suppressant, which is made from a plant grown in Southern Africa, is that it is an all-natural product and has no negative side effects. How does that sound?

*These Three Steps Will Assist You in Your Weight Loss Efforts While Improving Your Health Overall*

Something you must remember is that losing weight and improving health is never a one-step process. If you are serious about your health and weight, here's a surefire three-step plan to accomplish your goals:

1. Be sure to eat right. Eat a good balance of the right kinds of carbohydrates, vegetables, and protein. Try to stay away from is a real health killer. Eat fruit in its place.

2. Exercise right. I can't emphasize this enough. I believe that exercise is the most important part of you good-health plan. Walk! I'll say it again, please walk(pretty please). There is no better and more helpful exercise. Take at least a 20-minute brisk walk at least 4 days a week...6 would be even better.