Infiltration & Topical Flashcards
What two amide local anesthetics and one ester local anesthetic are most often used for infiltration anesthesia?
The two amide local anesthetics most often used for infiltration anesthesia are lidocaine (0.5% to 1.0%) and bupivacaine (0.125% and 0.25%). The most commonly used ester local anesthetic for infiltration anesthesia is procaine (0.5% to 1.0%). [Nagelhout & Plaus, N A , 4e. 2009 p159]
State the advantage of EMLA cream and the typical dosing.
EMLA cream is able to diffuse through the keratinized layer of intact skin to block neuronal transmission from dermal sensory receptors. EMLA cream is thus used for topical anesthesia of skin. The recommended dose of EMLA for minor dermal procedures is 2.5 g applied over a 20- to 25cm2 skin surface for at least 60 minutes before the procedure. For painful procedures, 2 g of EMLA cream per 10-cm2 of skin is applied and left in place for at least 2 hours. EMLA cream is useful for pain associated with venipuncture and arterial cannulation, skin graft harvesting, arteriovenous shunt procedures, and lumbar puncture. [Stoelting PPAP, 4e. 2006 p196; Miller 8rStoelting, Basics, 5e. 2007 p133; Cousins, Neural Blockade, 4e. 2009 p108]
Since EMLA cream contains prilocaine, methemoglobinemia may be a concern, even though the prilocaine is topically administered. What population of patients may be susceptible to methemoglobinemia following EMLA cream and why?
Methemoglobinemia may occur in children age
List 4 contraindications for EMLA cream.
EMLA cream is not recommended for: (1) use on mucous membranes, (2) use on skin wounds, (3) use on patients being treated with the antidysrhythmic agent mexiletine, and (4) use in patients with known history of allergy to amide local anesthetics. [Stoelting PPAP, 4e. 2006 p196]
