EMLA (EUTECTIC MIXTURE OF LIDOCAINE AND PRILOCAINE)

EMLA (EUTECTIC MIXTURE OF LIDOCAINE AND PRILOCAINE)
EMLA Cream
Classifications: local anesthetic;
Therapeutic: local anesthetic

Prototype: Procaine
Pregnancy Category: B

Availability

2.5% lidocaine/2.5% prilocaine cream

Action

EMLA cream is a mixture of lidocaine and prilocaine. The mixture forms a liquid at room temperature. Concentration of anesthetic in liquid versus an emulsifier is 80% versus 20%.

Therapeutic Effect

EMLA is a topical analgesic.

Uses

Topical anesthetic on normal intact skin for local anesthesia.

Unlabeled Uses

Topical anesthetic prior to leg ulcer debridement; treatment of postherpetic neuralgia.

Contraindications

Patients with known sensitivity to local anesthetics; patients with congenital or idiopathy methemoglobinemia; tympanic membrane perforation; children <1 mo of age.

Cautious Use

Acutely ill, debilitated, or older adult patients; severe liver disease; pregnancy (category B), lactation.

Route & Dosage

Topical Anesthetic
Adult/Child (>1 mo): Topical Apply 2.5 g of cream (? of 5 g tube) over 20–25 cm2 of skin, cover with occlusive dressing and wait at least 1 h, then remove dressing and wipe off cream, cleanse area with an antiseptic solution and prepare patient for the procedure

Administration

Topical
  • Apply a thick layer to skin (approximately ? of 5-g tube per 20–25 cm2 or 2 x 2 in) at site of procedure. Apply an occlusive dressing. Do not spread out cream. Seal edges of dressing well to avoid leakage.
  • Apply EMLA cream 1 h before routine procedure and 2 h before painful procedure.
  • Remove EMLA cream prior to skin puncture and clean area with an aseptic solution.
  • Store at room temperature 15°–30° C (59°–86° F).

Adverse Effects (≥1%)

Hematologic: Methemoglobinemia, especially in infants, small children, and patients with G6PD deficiency. Skin: Blanching and redness, itching, heat sensation. Body as a Whole: Edema, soreness, aching, numbness, heaviness. Other: The adverse effects of lidocaine could occur with large doses or if there is significant systemic absorption.

Interactions

Drug: May cause additive toxicity with class i antiarrhythmics; may increase risk of developing methemoglobin when used with acetaminophen, chloroquine, dapsone, fosphenytoin, nitrates and nitrites, nitric oxide, nitrofurantoin, nitroprusside, pamaquine, phenobarbital, phenytoin, primaquine, quinine, or sulfonamides.

Pharmacokinetics

Absorption: Penetrates intact skin. Onset: 15–60 min. Peak: 2–3 h. Duration: 1–2 h after removal of cream. Distribution: Crosses blood–brain barrier and placenta, distributed into breast milk. Metabolism: In liver. Elimination: 98% of absorbed dose is excreted in urine. Half-Life: 60–150 min.

Nursing Implications

Assessment & Drug Effects

  • Monitor for local skin reactions including erythema, edema, itching, abnormal temperature sensations, and rash. These reactions are very common and usually disappear in 1–2 h.
  • Note: Patients taking Class 1 antiarrhythmic drugs may experience toxic effects on the cardiovascular system. EMLA should be used with caution in these patients.
  • Wash immediately with water or saline if contact with the eye occurs; protect the eye until sensation returns.

Patient & Family Education

  • Skin analgesia lasts for 1 h following removal of the occlusive dressing. Analgesia may be accompanied by temporary loss of all sensation in the treated skin. Advise caution until sensation returns.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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