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Lidocaine - topical

Classification: A

Drug products: 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 code: C05AA01, D04AB01, N01BB02, N01BB20

Summary

Topical lidocaine has been shown to be similarly effective and safe in men and women.
 
In our opinion, the present evidence does not motivate differentiation in dosing or treatment between men and women.

Additional information

Pharmacokinetics and dosing

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 [1]. 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 [2].

Effects

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 [3].

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 [6]. 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 [7].

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 [8].

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 [9].

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 [10]. 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 [11]. 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 [12]. 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) [13].

Adverse effects

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 [1].

Reproductive health issues

Regarding teratogenic aspects, please consult the Drugs and Birth Defects Database (in Swedish, Janusmed fosterpåverkan).

Other information

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 [14].

Updated: 2019-02-26

Date of litterature search: 2017-07-17

References

  1. McCleskey PE, Patel SM, Mansalis KA, Elam AL, Kinsley TR. Serum lidocaine levels and cutaneous side effects after application of 23% lidocaine 7% tetracaine ointment to the face. Dermatol Surg. 2013;39:82-91. PubMed
  2. Langmack EL, Martin RJ, Pak J, Kraft M. Serum lidocaine concentrations in asthmatics undergoing research bronchoscopy. Chest. 2000;117:1055-60. PubMed
  3. Ho AL, Zakrzewski PA, Braga-Mele R. The effect of combined topical-intracameral anaesthesia on neuroleptic requirements during cataract surgery. Can J Ophthalmol. 2010;45:52-7. PubMed
  4. EMLA. Summary of Product Characteristics. Medical Products Agency (MPA); 2016.
  5. EMLA (lidocaine/prilocaine). Drugs.com [www]. [cited 2017-07-17]. länk
  6. Lim S, Julliard K. Evaluating the efficacy of EMLA topical anesthetic in sealant placement with rubber dam. Pediatr Dent. 2004;26:497-500. PubMed
  7. Cordoni A, Cordoni LE. Eutectic mixture of local anesthetics reduces pain during intravenous catheter insertion in the pediatric patient. Clin J Pain. 2001;17:115-8. PubMed
  8. Robinson PA, Carr S, Pearson S, Frampton C. Lignocaine is a better analgesic than either ethyl chloride or nitrous oxide for peripheral intravenous cannulation. Emerg Med Australas. 2007;19:427-32. PubMed
  9. Gursoy A, Ertugrul DT, Sahin M, Tutuncu NB, Demirer AN, Demirag NG. The analgesic efficacy of lidocaine/prilocaine (EMLA) cream during fine-needle aspiration biopsy of thyroid nodules. Clin Endocrinol (Oxf). 2007;66:691-4. PubMed
  10. Robinson ME, Riley JL, Brown FF, Gremillion H. Sex differences in response to cutaneous anesthesia: a double blind randomized study. Pain. 1998;77:143-9. PubMed
  11. Serour F, Ben-Yehuda Y, Boaz M. EMLA cream prior to digital nerve block for ingrown nail surgery does not reduce pain at injection of anesthetic solution. Acta Anaesthesiol Scand. 2002;46:203-6. PubMed
  12. Mansell-Gregory M, Romanowski B. Randomised double blind trial of EMLA for the control of pain related to cryotherapy in the treatment of genital HPV lesions. Sex Transm Infect. 1998;74:274-5. PubMed
  13. Froehlich F, Schwizer W, Thorens J, Köhler M, Gonvers JJ, Fried M. Conscious sedation for gastroscopy: patient tolerance and cardiorespiratory parameters. Gastroenterology. 1995;108:697-704. PubMed
  14. Bishai R, Taddio A, Bar-Oz B, Freedman MH, Koren G. Relative efficacy of amethocaine gel and lidocaine-prilocaine cream for Port-a-Cath puncture in children. Pediatrics. 1999;104:e31. PubMed

Authors: Mia von Euler

Reviewed by: Mia von Euler

Approved by: Karin Schenck-Gustafsson