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      Topical local anesthesia: focus on lidocaine–tetracaine combination

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          Abstract

          In recent years, the popularity of aesthetic and cosmetic procedures, often performed in outpatient settings, has strongly renewed interest in topical anesthetics. A number of different options are widely used, alone or in combination, in order to minimize the pain related to surgery. Moreover, interest in local anesthetics in the treatment of some painful degenerative conditions such as myofascial trigger point pain, shoulder impingement syndrome, or patellar tendinopathy is increasing. Numerous clinical trials have shown that lidocaine–tetracaine combination, recently approved for adults aged 18 or older, is effective and safe in managing pain. The present paper gives an overview of the recent literature regarding the efficacy and safety of lidocaine–tetracaine combination use.

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          Most cited references 24

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          Topical anesthetics for dermatologic procedures: a review.

          Practitioners are increasingly using topical anesthetics to decrease the pain associated with superficial dermatologic, aesthetic, and laser procedures. Numerous lidocaine-containing products are available, but comprehensive reviews are lacking regarding their relative safety profiles and appropriate dermatologic uses. A literature review of currently available topical anesthetics, their safety profiles, and dermatologic uses was conducted. Factors that should be considered to reduce the risk of side effects associated with the use of topical anesthetics include the amount of product used, body location, size of the surface area, and duration of product application. Many case reports document adverse outcomes associated with the use of compounded products that the Food and Drug Administration has not approved that have inappropriately high anesthetic concentrations and from the use of topical anesthetics on excessively large skin surface areas during laser treatments. Lidocaine-containing products play an integral role in cutaneous anesthesia by providing patient comfort with minimal side effects. Careful attention must be paid to the particular anatomic location, the total surface area covered, and the duration of anesthetic skin contact. © 2012 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.
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            EMLA-induced methemoglobinemia and systemic topical anesthetic toxicity.

            This case report illustrates an adult presenting with the simultaneous occurrence of both methemoglobinemia (MetHb) and systemic toxicity from the topical application of local anesthetics while undergoing laser epilation therapy of the legs. The concurrent development of both is considered uncommon in this setting and may have been related to several factors, including her recent previous treatment, increased absorption secondary to abraded skin with the addition of occlusive dressing, and possible alteration of protein binding and drug metabolism due to the use of medications. The clinical manifestations and mechanisms of MetHb and systemic local anesthetic toxicity are discussed.
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              A risk-benefit assessment of topical percutaneous local anaesthetics in children.

               S C Russell,  E Doyle (1997)
              Since its introduction, eutectic lidocaine-prilocaine cream ('EMLA')1 has been found to be an effective topical anaesthetic agent, with a high degree of efficacy, particularly for venepuncture and venous cannulation, and an impressive tolerability profile. Reports of adverse effects are remarkable for their rarity. The only problems that are likely to be encountered are oral ingestion of the cream (which may lead to anaesthesia of the oropharynx and possible toxicity secondary to rapid absorption of local anaesthetic from oral mucous membranes) and methaemoglobinaemia following repeated applications in neonates and infants. Analysis of the risks and benefits associated with its use comes down heavily in favour of the preparation. More recently, a preparation of tetracaine (amethocaine) has been marketed as a gel. Its advantages are a faster onset, and longer duration, of action than 'EMLA'. Although less widely used, it too has an impressive tolerability record. Concerns over the potential for anaphylactic type reactions due to its ester structure have not been realised in clinical practice. Of the other available preparations, lidocaine (lignocaine), applied iontophoretically, is unlikely to become popular because of the complexity of administration. A paste made of tetracaine, epinephrine (adrenaline) and cocaine (TAC) appears to be a far more toxic preparation on theoretical grounds, and this has been borne out in clinical practice; it is not as well tolerated as 'EMLA' or tetracaine gel. Ethyl chloride, although not a local anaesthetic, can safely provide cutaneous analgesia in children in circumstances when it is impractical to wait for a local anaesthetic preparation to take effect.
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                Author and article information

                Journal
                Local Reg Anesth
                Local Reg Anesth
                Local and Regional Anesthesia
                Local and Regional Anesthesia
                Dove Medical Press
                1178-7112
                2015
                27 November 2015
                : 8
                : 95-100
                Affiliations
                [1 ]Otorhinolaryngology Unit, Department of Surgery, Arcispedale Santa Maria Nuova – IRCCS, Reggio Emilia, Italy
                [2 ]Anesthesiology, Intensive Care, and Pain Medicine Unit, Department of Surgical Sciences, University Hospital of Parma, Parma, Italy
                [3 ]Anesthesiology and Intensive Care Unit, Department of Cardiology, Thoracic and Vascular Surgery, and Critical Care Medicine, Arcispedale Santa Maria Nuova – IRCCS, Reggio Emilia, Italy
                Author notes
                Correspondence: Davide Giordano, Otorhinolaryngology Unit, Department of Surgery, Arcispedale Santa Maria Nuova – IRCCS, viale Risorgimento 80, 42123 Reggio Emilia, Italy, Tel +39 05 2229 6273, Fax +39 05 2229 5839, Email davide.giordano@ 123456asmn.re.it
                Article
                lra-8-095
                10.2147/LRA.S41836
                4669927
                © 2015 Giordano et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Review

                Anesthesiology & Pain management

                lidocaine, tetracaine, local anesthetics, efficacy, safety

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