II. Indications
- Venipuncture
- Used prior to Local Anesthesia injection
III. Preparation: Ingredients
- Lidocaine 25 mg/ml
- Prilocaine 25 mg/ml
- Thickener, emulsifier, distilled water
- Buffered to pH of 9.4
IV. Technique
- Apply thick layer to skin surface
- Apply 1-2 grams per 10 cm^2
- Maximum dose 10 grams
- Cream applied to Epidermis
- Occlusive Dressing applied (Tegaderm, Opsite)
- Held in place for 60-90 minutes
- Apply for only 5-30 minutes if over diseased skin
- Duration of Anesthesia: 30-120 minutes
- Depth of penetration
- Applied for 60 minutes: 3 mm depth
- Applied for 90-120 minutes: 5 mm depth
V. Advantages
- Minimal systemic absorption
- No skin distortion
VI. Contraindications
- Age under 1 month old
- Methemoglobinemia
- Not FDA approved for open skin or mucous membranes
- Has however been used in Laceration Repair
- Zempsky (1997) Ann Emerg Med 30:163-6 [PubMed]
VII. Efficacy
- Not effective for pain reduction before venipuncture in infants <3 months
- Shahid (2019) Pediatrics 143(1) +PMID:30587535
VIII. References
- Pfenninger (1994) Procedures, Mosby, p. 135-155
- Kundu (2002) Am Fam Physician 66(1):99-102 [PubMed]