Question

Which of the following is true regarding the image provided? 

• A. EMLA contains ropivacaine and ligocaine.
• B. EMLA can lead to hemoglobinemia.
• C. EMLA contains 5 percent lignocaine.
• D. EMLA acts within 15 minutes.

Hint:

Always check the ingredients and possible side effects of any topical anesthetic. For EMLA, be aware of the risk of methemoglobinemia, especially with prolonged use.

Answer 1

The Correct Option is B

Step 1: Identify the agent in the picture.
The image depicts EMLA, the Eutectic Mixture of Local Anaesthetics, a topical cream applied to intact skin before venepuncture, minor procedures and paediatric injections.

Step 2: Recall its true composition.
EMLA is a 1:1 eutectic blend of two amide local anaesthetics: lignocaine (lidocaine) 2.5% and prilocaine 2.5%. It does NOT contain ropivacaine, and it is not 5% lignocaine alone. So any option claiming ropivacaine or 5% lignocaine is built on a wrong formula.

Step 3: Recall its kinetics.
Because the cream must diffuse through the stratum corneum, onset is slow. Adequate dermal anaesthesia needs roughly 45-60 minutes of contact under an occlusive dressing, so the claim that it acts within 15 minutes is also false.

Step 4: Find the one correct statement via the prilocaine link.
The prilocaine component is metabolised to o-toluidine, an oxidant that converts the ferrous iron of haemoglobin to the ferric form. This produces methaemoglobin, which cannot carry oxygen $-$ i.e. methaemoglobinaemia. This is the recognised serious adverse effect of EMLA, especially in neonates and infants.

Step 5: Conclusion.
Eliminating the three false statements (wrong drugs, wrong strength, wrong onset) leaves the prilocaine-driven oxidant injury as the only true statement: EMLA can lead to (met)haemoglobinaemia.

Final answer: Option 2 - EMLA can lead to hemoglobinemia.