Local anesthesia of the skin before surgical procedures within the skin, puncture and catheterization of veins, blood collection for examinations. In addition, the cream is used for local anesthesia of the genital mucosa before surgery or anesthesia.
Composition:
1 g of cream contains 25 mg Lidocaine and 25 mg prilocaine. 1 patch with a surface of 10 cm2 contains 25 mg lidocaine and 25 mg prilocaine.
Action:
Lidocaine and prilocaine contained in the preparations belong to local anesthetics with amide structure. They cause local, reversible suppression of nerve fibers by inhibiting the sodium potassium pump and inhibition of cell membrane permeability to ions. The degree of anesthesia depends on the time of leaving the preparations on the skin and the dose used. In the case of leaving the cream or patch on the skin for 1-2 h, the anesthesia is maintained for 2 h after removing the occlusive dressing or patch. There is a vascular response: vasoconstriction (blanching) or vasodilatation (redness of the skin). This reaction occurs much faster in patients with atopic dermatitis. The time from applying the cream to the desired degree of anesthesia is shorter when applied to mucous membranes. Absorption is much faster than when used on intact skin. The maximum concentrations achieved by lidocaine and prilocaine in the blood depend on the dose, location (greater in well-supplied places, e.g. the face), skin lesions occurring, time and size of the exposure field and are significantly lower than toxic concentrations: e.g. for adults after application, 60 g of cream per 400 cm2 unharmed skin / 3 h, 3% of lidocaine and 5% of prilocaine are absorbed into the systemic circulation. Lidocaine and prilocaine go into breast milk (with respect to a properly used preparation - the risk of side effects in the newborn is minimal).
Contraindications:
Hypersensitivity to local anesthetic drugs or other ingredients. Methemoglobinemia (congenital or idiopathic). Plaster: do not use in premature babies (born before 37 weeks of pregnancy).
Precautions:
Use with caution in patients with G-6-PD deficiency (higher risk of methaemoglobinaemia), atopic dermatitis (duration of application should not be longer than 15-30 min). The product should be used carefully in the eye area, because it causes irritation of the cornea and may weaken the defense reflexes by anesthetizing the cornea. Do not use the preparation on open wounds due to insufficient data on the absorption of active substances. Use caution before applying subcutaneous administration of live vaccines, due to the bacteriostatic and antiviral effects of lidocaine and prilocaine in concentrations greater than 0.5-2% - it is recommended to control the immune response after administration of the vaccines. Due to insufficient clinical data, the preparation should not be used in children under 3 years old, between 3 and 12 months old, receiving other methaemoglobin inducing drugs (eg sulphonamides). The cream should not be used in children on mucous membranes. Patients receiving class III antiarrhythmics (eg amiodarone) who are undergoing creams should be closely monitored and should be monitored for electrocardiogram monitoring due to the possibility of adding up to lidocaine.
Pregnancy and lactation:
The preparation should be used with caution in pregnant women. Lidocaine and prilocaine are excreted in breast milk in amounts that do not pose a risk to the breast-fed child.
Side effects:
Common: temporary fading, swelling or redness of the skin. Uncommon: pruritus and burning of the skin. Rare: allergic reactions (in the most severe cases, anaphylactic shock); methemoglobinemia in children; small atrophic changes at the site of application (purpura or ecchymosis), especially after long-term use in children with atopic dermatitis or infectious mucosa and irritation of the cornea after accidental contact with the preparation.
Dosage:
Cream. A thick layer of cream should be applied to the skin and covered with an occlusive dressing (foil).An occlusive dressing is necessary in any case of skin anesthesia. Adults. Anesthesia of the skin: treatments on a small area of the skin (venipuncture, small surgical procedures) - about 2 g of cream, duration of use 1-5 h; treatments on larger surfaces (eg taking skin grafts) - 1.5-2 g cream / 10 cm2, application time 2-5 h. Anesthesia of mucous membranes: 5-10 g of cream for 10-15 minutes without the use of occlusive dressings, the treatment should be started immediately after washing the cream. Children aged 3-12 months - up to 2 g of cream up to a surface of 16 cm2, application time 1-2 h; children aged 1-6 years - up to 10 g of cream up to a surface of 100 cm2, application time 1-5 h; children aged 6-12 - up to 20 g of cream up to a surface of 200 cm2, application time 1-5 h. Cover the cream with an occlusive dressing. In children with atopic dermatitis, the cream should not be used for more than 30 minutes.Slices. Adults: 1 or more patches to be applied to the anesthetized place, duration of use 1-5 hours. Children aged 3-12 months: stick the plaster on the anesthetized place, time of use 1-4 hours, do not attach at the same time more than 2 slices. Children from 13 months till 5 o'clock: stick the patch on the anesthetized place, application time 1-5 hours, do not attach more than 10 patches at the same time. Children aged 6-12: stick the patch on the anesthetized place, the duration of use 1-5 hours, do not attach at the same time more than 20 patches.
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