Clinical use of topical anesthetics in children gas jewelry

A general approach to the management of pain and sedation in children, and prevention and treatment of neonatal pain are discussed elsewhere. (See "Evaluation and management of pain in children" and "Prevention and treatment of neonatal pain".)

Local anesthetics work by reversibly blocking sodium channels within the nerve fibers, which prevents transmission of pain signals by disrupting depolarization of the nerve (see "Subcutaneous infiltration of local anesthetics", section on ‘Anatomy and physiology’). In the skin, these nerve fibers are located in the dermis and epidermis and are covered by the water impermeable stratum corneum. Topical anesthetics overcome this barrier by either passive diffusion from creams or gels or the use of needle-free methods such as pressured gas drug delivery, heat-enhanced diffusion, or iontophoresis [ 1].

General principles — Painful procedures, such as venipuncture, intravenous (IV) cannulation, intramuscular (IM) injection, laceration repair, and lumbar puncture (LP) are common in pediatrics and cause distress to children and their parents. The stress response to pain is associated with metabolic and hormonal changes that are attenuated by local anesthetics [ 2,3].

Local anesthetics can be injected; however, topical analgesics, either topical anesthetics or vapocoolant spray can be applied without needles and can reduce the need for physical and chemical restraints [ 4]. These agents also avoid the tissue distortion that occurs with infiltrated anesthetics [ 5]. As discussed below, the selection of the topical anesthetic primarily depends upon the type and urgency of the procedure, the provider’s knowledge and comfort with different types of application procedures, and patient preference ( table 1).

• Smith GA, Strausbaugh SD, Harbeck-Weber C, et al. Comparison of topical anesthetics without cocaine to tetracaine-adrenaline-cocaine and lidocaine infiltration during repair of lacerations: bupivacaine-norepinephrine is an effective new topical anesthetic agent. Pediatrics 1996; 97:301.

• Eichenfield LF, Funk A, Fallon-Friedlander S, Cunningham BB. A clinical study to evaluate the efficacy of ELA-Max (4% liposomal lidocaine) as compared with eutectic mixture of local anesthetics cream for pain reduction of venipuncture in children. Pediatrics 2002; 109:1093.

• Zempsky WT, Bean-Lijewski J, Kauffman RE, et al. Needle-free powder lidocaine delivery system provides rapid effective analgesia for venipuncture or cannulation pain in children: randomized, double-blind Comparison of Venipuncture and Venous Cannulation Pain After Fast-Onset Needle-Free Powder Lidocaine or Placebo Treatment trial. Pediatrics 2008; 121:979.

• Zempsky WT, Cravero JP, American Academy of Pediatrics Committee on Pediatric Emergency Medicine and Section on Anesthesiology and Pain Medicine. Relief of pain and anxiety in pediatric patients in emergency medical systems. Pediatrics 2004; 114:1348.

• Sridharan K, Sivaramakrishnan G. Pharmacological interventions for reducing pain related to immunization or intramuscular injection in children: A mixed treatment comparison network meta-analysis of randomized controlled clinical trials. J Child Health Care 2018; :1367493518760735.

• Milani AS, Zand V, Abdollahi AA, et al. Effect of Topical Anesthesia with Lidocaine-prilocaine (EMLA) Cream and Local Pressure on Pain during Infiltration Injection for Maxillary Canines: A Randomized Double-blind clinical trial. J Contemp Dent Pract 2016; 17:592.