Preparat: Denela, Emla, EMLA®, Instillagel®, Lidocaine Accord, Lidocaine Hydrochloride, Lidocaine Hydrochloride oral topical solution, USP (viscous) 2%, Lidocaine Viscous 2%, Lidodan Viscous, Lidoderm, Lidokain APL, Lidokain Ebb, Lidokain Mylan, Lidokain/Prilokain Alternova, Lidokainhydroklorid i Oral Cleaner APL, Lidokainhydroklorid APL, Maxilene, Oraqix, pms-Lidocaine Viscous 2%, Tapin, Versatis, Versatis®, Xylocain, Xylocain Pumpspray, Xylocain®, Xylocain® utan konserveringsmedel, Xylocain® viskös, Xylocaine, Xylocaine 2% Viscous, Xylocaine visqueuse, XYLOCAINE® VISCOUS 2%, Xyloproct®
ATC kod: C05AA01, D04AB01, N01BB02, N01BB20
Topikalt lidokain har visats ha likartad effekt och säkerhet hos män och kvinnor.
Vår bedömning är att nuvarande kunskapsunderlag inte motiverar skillnad i dosering eller behandling mellan kvinnor och män.
A study in 52 volunteers (20 men, 32 women) measuring S-lidocaine levels after a standardized application of 23% lidocaine/7% tetracaine compounded anesthetic to the face found higher concentrations in men and also in persons with greater facial surface and non-white ethnicity . In contrast to this, a study on persons with mild to moderate asthma, the lidocaine concentration after local administration in the upper airways before bronchoscopy (21 men, 30 women) was similar in men and women .
The effect of topical lidocaine has been shown in both males and females and the effect does not seem to be dependent on the patient’s sex.
A chart review of patients undergoing phacoemulsification (40 men, 84 women) found a reduction in fentanyl requirements with the addition of intracameral lidocaine to topical anesthesia during cataract surgery independent of patient’s sex .
In a randomized trial in children 6-12 years (13 boys, 18 girls), EMLA (2.5% each of lidocaine and prilocaine [4-5]. treatment before dental dam placement was found to be more effective than placebo in both boys and girls regardless of age . Another placebo controlled pediatric study on the effect of EMLA to reduce pain during intravenous catheter insertion (26 boys, 31 girls aged 4-12) found a positive effect, regardless of age or sex .
A randomized study in patients being subjected to peripheral i.v. cannulation (149 men, 141 women) showed less patient discomfort, measured with a visual analogue scale (VAS), in both men and women after administration of 0.1 mL of intradermal 1% lidocaine .
In a double-blind, placebo-controlled clinical trial the effect on 2,5 g of EMLA administration to patients undergoing fine needle aspiration of the thyroid nodules was evaluated (14 men, 85 women). EMLA treated patients experienced less pain regardless of patient’s sex. Although the male group was small, women were found to experience more pain overall .
There are two small studies showing sex differences in the groups treated with topical lidocaine but not in the placebo groups. One randomized study used an algometer to test pressure pain in healthy volunteers (23 men, 21 women) and found men but not women to experience less pain in the lidocaine but not in the placebo group . Similarly, a double-blind placebo controlled, randomized, prospective study on the effect of EMLA before digital ring block for surgery for ingrown big toenail (42 men, 39 women) found no effect of EMLA treatment over all but less pain in men in the lidocaine group . The opposite was found in a study of the effect of EMLA before cryotherapy for Human papillomavirus (HPV) (20 men, 20 women) where men reported higher pain scores in the EMLA group . Together with age above 40 years and lower anxiety level before procedure, male sex was found to be associated with lower estimated pain on the VAS scale over-all in a randomized double-blind placebo-controlled study of the effect of local lidocaine before gastroscopy (119 men, 79 women) .
In the pharmacokinetic study mentioned above (20 men, 32 women) cutaneous side effects after a standardized application of 23% lidocaine/7% tetracaine compounded anesthetic to the face was also evaluated. No difference between men and women in reporting of side effects was found .
Regarding teratogenic aspects, please consult the Drugs and Birth Defects Database (in Swedish, Janusmed fosterpåverkan).
In a randomized, blinded study comparing topical amethocaine with EMLA before Port-a-Cath procedures in children (27 boys, 12 girls aged 5-16) no difference between boys or girls were found in their own or their parents pain assessment. However, nurses estimated the pain to be worse for boys and younger children .
Användningen av topikalt lidokain sker mestadels på sjukhus och data över könsuppdelad användning saknas för den delen.
Faktagranskat av: Mia von Euler
Godkänt av: Karin Schenck-Gustafsson