INSTRUCTIONS:
1. For each chapter that teaches about medications, fill in the following table regarding the chosen meds.
CLASS: anesthetics
GENERIC NAME: Lidocaine/prilocaine
TRADE NAMES: EMLA, Oraqix
(topical/local)
MOA: Produces local anesthesia by inhibiting transport of ions across neuronal membranes, thereby preventing initiation and conduction
of normal nerve impulses. Combination of two anesthetics is applied as a system consisting of a cream under an occlusive dressing. Active
drug is released into the dermal and epidermal skin layers, resulting in accumulation of local anesthetic in the regions of dermal pain
receptors and nerve endings.
Therapeutic Effects:
Anesthetic action localized to the area of the application.
INDICATIONS: • Produces local anesthesia prior to minor painful procedures including:
• Insertion of cannulae or needles,
• Arterial/venous/lumbar puncture,
• Intramuscular injections,
• Subcutaneous injections,
• Dermal procedures,
• Laser treatments,
• Circumcision.
• When applied to genital mucous membranes in preparation for superficial minor surgery or as preparation for infiltration anesthesia.
• Produces localized anesthesia in periodontal pockets during scaling and/or root planing (Oraqix only).
CONTRAINDICATIONS/PRECAUTIONS: Contraindicated in:
• Hypersensitivity to lidocaine, prilocaine, or any other amide-type local anesthetic;
• Hypersensitivity to any other product in the formulation;
• Should not be applied to middle ear, mucous membranes, or broken/inflamed skin;
• Pedi: Infants <1 mo if gestational age is <37 weeks;
• Pedi: Infants <12 mo receiving methemoglobin-inducing agents.
Use Cautiously in:
• Repeated use or use on large areas of skin (more likely to result in systemic absorption);
• Acutely ill, or debilitated patients (
risk of absorption and systemic effects);
• Severe liver disease;
• Glucose-6-phosphate dehydrogenase deficiency, history of methemoglobinemia, cardiac or pulmonary disease, or concurrent exposure to
oxidizing agents (or metabolites of these agents) (
• OB: Use only if clearly needed;
risk of methemoglobinemia);
• Lactation: Usually compatible with breast feeding (AAP);
• Pedi: Infants <6 mo (
37 wk gestation (
• Geri: May have
risk of methemoglobinemia); area/duration of treatment should be limited in neonates and children <20 kg or
susceptibility to methemoglobinemia);
absorption and risk of systemic effects.
INTERACTIONS with other Drugs/Substances: Drug-Drug:
• Concurrent use with class I antiarrhythmics including mexiletine may result in adverse cardiovascular effects.
• Concurrent use with other local anesthetics may result in
toxicity.
• Concurrent use
of acetaminophen, benzocaine, bupivacaine, chloroquine, cyclophosphamide, dapsone, flutamide, hydroxyurea, ifosfamide, meto
clopramide, nitrofurantoin, nitroglycerin, nitroprusside, nitrous
oxide, phenobarbital, phenytoin, prilocaine, primaquine, procaine, quinine, rasburicase, ropivacaine, sulfonamides, tetracaine,
and valproate may
PATIENT RESPONSE /
REACTIONS:
DESIRED OUTCOME:
Anesthetic action
localized to the area of
the application.
risk of methemoglobinemia; monitor closely; avoid concurrent use in children <12 mo.
COMMON SIDE EFFECTS:
Hemat: methemoglobinemia.
Local: blanching, redness,
alteration in temperature
sensation, edema, itching,
rash, hyperpigmentation.
ADVERSE REACTIONS:
Misc: HYPERSENSITIVITY
REACTIONS (INCLUDING
ANAPHYLAXIS).
S/S TOXICITY: Early
symptoms are
circumoral numbness,
tongue paresthesia,
and dizziness. Sensory
complaints may
include tinnitus and
blurred vision.
Excitatory signs, such
as restlessness,
agitation, nervousness,
or paranoia, may
progress to muscle
twitches and seizures.
Ultimately, with large
overdoses, CNS
depression, including
unconsciousness and
coma, can occur.
TOXICITY/OVERDOSE
TX: Airway
management: ventilate
with 100% oxygen
Seizure suppression:
benzodiazepines are
preferred; AVOID
propofol in patients
having signs of
cardiovascular
instability
NURSING ACTIONS:
Hypotension and
bradycardia can also
be side effects of
relative local
anesthetic overdoses
that sometimes occur
during neuraxial
blockade or nerve
blocks performed near
the CNS.
ASSESS: • Assess application CARE/IMPLEMENT:
TEACH: • Explain the
EVALUATE: Anesthesia
site for open wounds. Apply
• Topical: EMLA: When
purpose of cream and
in the area of
only to intact skin.
used for minor dermal
occlusive dressing to
application.
• Assess application site for
procedures (venipuncture, patient and parents.
anesthesia following removal IV cannulation, arterial
Inform the patient that
of system and prior to
puncture, lumbar
lidocaine/prilocaine
procedure.
puncture), apply the 2.5-g cream may block all
tube of cream (1/2 of the
sensations in the
5-g tube) to each 2 in. by 2 treated skin. Caution
in. area of skin in
patient to avoid
a thick layer at the site of
trauma to the area
the impending procedure. from scratching,
Remove the center cutout
rubbing, or exposure
piece from an occlusive
to extreme heat or cold
dressing (supplied with
temperatures until all
the 5-g tube) and peel the
sensation has
paper liner from the
returned.
paper-framed dressing.
Home Care Issues:
Cover the
• Instruct patient or
lidocaine/prilocaine cream parent in proper
so that there is
application. Provide a
a thick layer of cream
diagram of location for
underneath the occlusive
application.
dressing. Do not spread
out or rub in the cream.
Smooth the dressing edges
carefully and ensure it is
secure to avoid leakage.
Remove the paper frame
and mark the time of
application on the
occlusive dressing.
Lidocaine/prilocaine
cream must be applied at
least 1 hr before the start
of a minor dermal
procedure (venipuncture,
IV cannulation).
Anesthesia may be more
profound with 90 min-2 hr
application. Remove the
occlusive dressing and
wipe off the
lidocaine/prilocaine
cream. Clean the entire
area with antiseptic
solution and prepare the
patient for the procedure.
• For major dermal
procedures (skin graft
harvesting), follow the
same procedure using
larger amounts of
lidocaine/prilocaine cream
and the appropriate-size
occlusive dressing.
Lidocaine/prilocaine
cream must be applied at
least 2 hr before major
dermal procedures.
SPECIAL CONSIDERATIONS/NOTES:
References
Klaus, D. Torp et. al. July 14, 2021 Lidocaine Toxicity National Center for Biotechnology Information
https://www.ncbi.nlm.nih.gov/books/NBK482479/
Lilley, J.S.S.R.C. L. Pharmacology and the Nursing Process. [VitalSource Bookshelf]. Retrieved
from https://online.vitalsource.com/#/books/9780323529495/
Vallerand, April., Sanoski, Cynthia., eds. 2021. Davis's Drug Guide for Nurses - 17th Ed. Philadelphia, PA. F. A. Davis Company. STAT!Ref Online
Electronic Medical Library. https://online.statref.com/document/tYCn9emWjVDZaYjX_cjgjD