EMLA topical lidocaine-prilocaine

Generic Names topical lidocaine/prilocaine, topical lidocaine/tetracaine, tetracaine gel, 4% liposomal lidocaine, 1,1,1,3,3-pentafluoropro-pane and 1,1,1,2-tetrafluoroethane Trade/Proprietary Names EMLA (Eutectic Mixture of Local Anesthetics), Synera", Ametop Gel , LMX-4 , PainEase (vapocoolant spray)... 

Lidocaine/Prilocaine (EMLA/ IMX) [Topical Anesthetic] Uses ... 

EMLA cream (lidocaine 2.5% and prilocaine 2.5%) consists of a eutectic mixture of focal anesthetics. It is used to provide topical anesthetic to intact skin. Other topical preparations are effective only on mucosal surfaces. EMLA has been shown to reduce pain on venipuncture and provide substantial anesthesia for skin graft donor sites. No significant local or systemic toxicity has been demonstrated. 

Clinical use Topical anesthesia is easily achieved using an eutectic mixture of the LAs prilocaine and lidocaine (EMLA, see Lidocaine). 

Topical anesthetics such as EMLA cream, which is a mixture of lidocaine and prilocaine, can be quite effective in reducing pain associated with venipunture or intravenous line insertion, circumcision, and laser treatment of port wine stains (Wilder, 2000). 

For topical effect on intact skin for needling procedures a eutectic mixture of bases of prilocaine or lidocaine is used (EMLA — eutectic mixture of... 

Lidocaine is the most widely used aminoamide local anesthetic agent, with a low toxic potential its effects are mostly typical for this class of drug. It can be given by injection or topically and is also combined with prilocaine in Emla for topical administration. It is also used as an antidysrhythmic drug and has occasionally been used in other conditions, such as multiple sclerosis, chronic daily headache, migraine and cluster headaches, and neuropathic pain, such as postherpetic neuralgia. 

Prilocaine is an aminoamide local anesthetic. It can be used on its own, but it is also included in Emla in a eutectic combination with lidocaine (25 mg/ml each), which is widely used as a local anesthetic in topical administration for, for example, superficial surgery and venepuncture. 

EMLA (eutectic mixture of local anaesthetics a combination of two local anaesthetics, lidocaine and prilocaine in a cream) is capable of producing skin thickness analgesia from topical administration. The cream is applied for a period of 1-2 hours under an occlusive dressing. EMLA is indicated prior to venepuncture (particularly in children) and whenever pre-injection analgesia of the skin is required. 

The introduction of a eutectic mixture of lidocaine (2.5%) and prilocaine (2.5%) (EMLa) bridges the gap between topical and infiltration anesthesia. The efficacy of this combination lies in the fact that the mixture of prilocaine and lidocaine has a melting point less than that of either compound alone, existing at room temperature as an oil that can penetrate intact skin. EMLA cream produces anesthesia to a maximum depth of 5 mm and is applied as a cream on intact skin under an occlusive dressing, for procedures involving skin and superficial subcutaneous structures (e.g., venipuncture and skin graft harvesting). EMLA must not be used on mucous membranes or abraded skin, as rapid absorption across these surfaces may result in systemic toxicity. 

As mentioned previously, our practice is to premedicate patients for medium-depth peels with lorazepam (Ativan) or an oral analgesic. We have found that even with no oral analgesic or antianxiety agent the peel is well tolerated if, after the application of the Jessner s solution or glycolic acid peel prior to the medium-depth peel, a topical anesthetic is generously applied (EMLA, lidocaine 2.5% and prilocaine 2.5%) and left in place for 15 minutes. The topical anesthetic is wiped clean and dry with moistened gauze. (This step is performed between the superficial peel and the medium-depth peel.)... 

Local anesthetics or sedation are not required for the CROSS. Generally, patients feel bearable prickling and burning sensation during the procedure. If needed, a topical anesthetic cream, such as EMLA cream (eutectic mixture of 2.5% lidocaine-HCl and 2.5% prilocaine ... 

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