EMLA (EUTECTIC MIXTURE OF LIDOCAINE AND PRILOCAINE) EMLA Cream Classifications: local anesthetic; Therapeutic: local anesthetic Prototype: Procaine Pregnancy Category: B
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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 2025 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
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Administration
Topical
- Apply a thick layer to skin (approximately ? of 5-g tube per 2025 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: 1560 min.
Peak: 23 h.
Duration: 12 h after removal of cream.
Distribution: Crosses bloodbrain barrier and placenta, distributed into breast milk.
Metabolism: In liver.
Elimination: 98% of absorbed dose is excreted in urine.
Half-Life: 60150 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 12 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.