Prilocaine EMLA

Dibucaine (Nupercainal) Lidocaine Prilocaine (EMLA, LMX) Lidocaine/Tetracaine Transdermal (Synera)... 

Rx with epinephrine (LidoSite, Xylocaine with Epinephrine) Prilocaine (EMLA) Cfiemical Class Amide derivative... 

LroOCAINE HYDROCHLORIDE/PRILOCAINE (EMLA cream, 2.5% lidocaine and 2.5% prilocaine)... 

A safe IV line is always necessary, and our preference goes to an antecubital catheter. The largest possible size is chosen. Placement of the catheter is ideally performed by a nurse in the outpatient suite after skin preparation with anesthetic cream (lidocaine-prilocaine, Emla ). This catheter makes it possible to use a power injector. Power injection provides an excellent examination quality, and continuous flow decreases the risk of extra vascular passage. The injection should be visually monitored and stopped in case of extra-vascular passage. In younger children, hand injection under visual control seems safer. 

Since TCA in higher concentrations tends to produce increased scarring and hypopigmenta-tion, 70% glycolic acid solution was applied to the entire face of patients and diluted with water after 2 min. This was followed by the sequential application of EMLA cream (lidocaine 2.5% and prilocaine 2.5%) or ELA-Max cream (lidocaine 4%) to selected areas on the face for 30 min without occlusion. These agents were then removed and 35% TCA was applied to the entire face [10]. 

Benzocaine, cetacaine, EMLA cream, lidocaine, prilocaine, and... 

Similar to Voltaren" Emulgel, oily droplets of an eutectic mixture of lidocaine and prilocaine are dispersed in a hydrogel to provide local anesthesia to the skin for injections and siugical treatment (Emla cream). A further possibility is the dermal administration of a liposome dispersion as a spray (Heparin PUR ratiopharm Spriih-gel "). After administration, water and isopropylic alcohol evaporate partially resulting in an increase of concentration and in a transition from the initial liposome dispersion into a lamellar liquid crystal [32]. The therapeutic effect appears to be influenced favorably by the presence of lecithins rather than by the degree of liposome dispersion. 

III.b.8.1. Skin. Surface anaesthesia of the skin can be produced with help of a cream containing a eutectic mixture of local anaesthetics (EMLA), which is a water/oil emulsion of equal parts of prilocaine and lidocaine with particularly good penetration capacity. EMLA is applied under occlusion, around 40-60 minutes before the planned intervention. This is an effective way of producing anaesthesia before needle punctures and minor, painful, procedures. The method is excellent, particularly in paediatrics, to reduce fear and pain. 

Percutaneous drug absorption can present special problems in newborns, especially in preterm infants. While the skin of a newborn term infant may have the same protective capacity as the skin of an adult, a preterm infant will not have this protective barrier until after 2 to 3 weeks of life. Excessive percutaneous absorption has caused significant toxicity to preterm babies. Absorption of hexachlorophene soap used to bathe newborns has resulted in brain damage and death. Aniline dyes on hospital linen have caused cyanosis secondary to methemoglobinemia, and EMLA (lidocaine/prilocaine) cream may cause methemoglobinemia when administered to infants less than 3 months of age. 

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. 

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). 

EMLA cream (lidocaine (lignocaine) 2.5% and prilocaine 2.5%) is an emulsion in which the oil phase is a eutectic mixture of lidocaine and prilocaine in a ratio of 1 1 by weight. It is available in 5 g and 30 g tubes. It is also available as an anaesthetic disc. This consists of a single-dose unit of EMLA contained within an occlusive dressing. The disc contains 1 g EMLA emulsion, the active contact surface being approximately 10 cm2. The surface area of the entire anaesthetic disc is approximately 40 cm2. EMLA (1 g) contains lidocaine 25 mg, prilocaine 25 mg with thickening agents, water, NaHCOB, etc., at a pH of about 9. 

EMLA applied to intact skin provides dermal analgesia by the release of lidocaine and prilocaine from the cream into the epidermal and dermal layers of the skin. There is cumulation of lidocaine and prilocaine in the vicinity of dermal pain receptors and nerve endings. The quality and duration of dermal analgesia depends primarily on the duration of application. EMLA should be applied 1-2 hours before the planned intervention, e.g. venepuncture, split skin harvesting. 

Parenteral 10 mg/mL lidocaine plus 3.75 mg/mL bupivacaine for injection Lidocaine and prilocaine eutectic mixture (EMLA cream)... 

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

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. 

In eight episodes of toxic methemoglobinemia in seven premature infants after the combination of caudal anesthesia (prilocaine 5.4—6.7 mg/kg) and Emla cream (prilocaine 12.5 mg) for herniotomy, the highest methe-moglobin concentration 5.5 hours after anesthesia was 31% (86). All the infants were sjmptomatic, with mottled skin, pallor, cyanosis, and poor peripheral perfusion. The most severe symptoms occurred at 3-8 hours and disappeared within 10-20 hours. The authors stressed the importance of recognizing the poor tolerance of premature infants to methemoglobinemia and that whereas topical prilocaine is relatively safe, caudal administration is not. 

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. 

A 5-year-old child had 35 g of Emla apphed under an occlusive dressing to eczematous skin in preparation for cryotherapy for molluscum contagiosum (3). Within 1 hour, the child had a generalized seizure that lasted 10 minutes. The plasma concentrations of lidocaine and prilocaine 30 minutes later were 5.5 and 2.0 pg/ml, respectively, and 6 hours later, the methemoglobin concentration was 19%. The child was given vitamin C 500 mg intravenously, and 2 days later had a methemoglobin concentration of 0.3%. 

Local anesthetics are effective when applied to mucous membranes or to the cornea (see Ch. 13) but, with the exception of EMLA cream (a mixture of 2.5% prilocaine and 2.5% lidocaine), are ineffective when applied to intact skin. Common... 

Mixing lidocaine base and prilocaine base in equal parts, at room temperature, gives a eutectic mixture. This mixture is emulsified in a base that consists mainly of water and polyoxyethylene castor oil, and the anesthetics are added to the oily phase. Phenol has an excellent oil/water partition coelEcient. The oils lower the toxicity of phenol, but also slow down its rate of penetration as well as absorption of the local anesthetics. There is a competition between the phenol solution and the EMLA, which changes the activity and penetration of the combined molecules. 

The presence of prilocaine is a (relative) contraindication to combining EMLA with products with a potential to cause methemoglobinemia. Combined use with paracetamol (acetaminophen), for example, is to be avoided. Paracetamol is a derivative of phenol (N-acetyl-para-aminophenol) and is subject to the same detoxification pathways as phenol. Paracetamol inherits its properties of causing methemoglobinemia from phenol. Large doses of EMLA (>600 mg of prilocaine, or four 5 g tubes) should therefore not be applied prior to phenol. 

Juhlin L, Hagglund G, Evers H. Absorption of lidocaine and prilocaine after application of a eutectic mixture of local anesthetic (EMLA) on normal and diseased skin. Acta Derm Venerol (Stock) 1989 69 18-22. 

EMLA Anesthetic Local anesthetic prior to Lidocaine and prilocaine 3 hr to deaden tissue 10 (contains 1 g ... 

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