Title: Advances in office anesthesia.
Author: Whealton EG
Journal: J Am Board Fam Pract 11(3):200-206, 1998
Affiliated institution: Department of Family Medicine, Naval Medical Center, Portsmouth, Virginia. (reprints: Edward G. Whealton, MD, 160 Sir Oliver Road, Norfolk, VA 23505.)
Background: Recent developments in anesthesia applicable to family practice settings are reviewed. Methods: MEDLINE was searched using the key words "EMLA"; "iontophoresis"; "lidocaine," "tetracaine, adrenaline, cocaine"; and "lidocaine, epinephrine, tetracaine." Results and Conclusions: Clinical experience has shown that there is a definite and evolving role for the newer methods of office anesthesia. Patient care can be improved by reducing the discomfort of patient procedures.
Eutectic Mixture of Local Anesthetics – EMLA
EMLA is an abbreviation of eutectic mixture of local anesthetics. It is a compound formed by combining 25 mg/mL of lidocaine, 25 mg/mL of prilocaine, a thickener, an emulgent, and distilled water with pH adjusted to 9.4. It is applied in a thick layer, covered with a patch (Tegaderm), and usually left on for 30 to 60 minutes. The effectiveness of anesthesia will increase during the 30 to 60 minutes after removal. The application can result in pallor and then erythema of the affected skin. It has not been studied in human lacerations.
Systemic toxicity from EMLA is extremely rare. Monitored absorption levels of prilocaine and lidocaine from EMLA have been in the low 100 ng/mL range; lidocaine toxicity occurs at 3 to 5