Lidocaine 70mg / Tetracaine 70mg medicated plasters

BackgroundVenipuncture and intravenous cannulation are common procedures in hospitals that often cause pain, particularly in children. Despite the availability of various local analgesia methods to alleviate needle-associated pain, the most effective approach remains unknown. The objective of this study is to compare and rank the efficacy of different local analgesia methods in reducing pain in children undergoing venipuncture and intravenous cannulation.MethodSix databases including PubMed, Embase, CINAHL, Scopus, Web of Science, and the Cochrane Library were searched from January 1,1990 to December 1,2024. The primary outcome is the self-reported pain. We assessed the certainty of the body of evidence from the NMA for the primary outcome based on CINeMA.Result40 RCTs consisting of 4481 children and 9 local analgesia methods were included in the analysis. Results showed that vapocoolant spray was no more effective than placebo or routine care in reducing needle-associated pain in children. Other interventions including EMLA cream, lidocaine cream, lidocaine iontophoresis, amethocaine, needle-free lidocaine injection system, EMLA patch, lidocaine/tetracaine heating patch and Buzzy produced greater pain reduction in children compared to placebo and routine care. Amethocaine was the most effective local analgesia method with the probability of 57.6% being the best, followed by Buzzy and lidocaine iontophoresis with the probability of 17.0% and 8.4%, respectively.ConclusionMost local analgesia methods were effective in relieving pain in children undergoing venipuncture and intravenous cannulation except vapocoolant spray which did not show greater pain reduction than placebo or routine care. Amethocaine, Buzzy and lidocaine iontophoresis are the top 3 local analgesia methods to relieve pain in children undergoing venipuncture and intravenous cannulation. However, due to the limited number of direct comparisons, interpretation of some results should be made with caution.

Abstract licence: CC BY-NC-ND

PurposeHealthcare professionals (HCP) perform various needle procedures that can be distressing and painful for children and adults. Even though many strategies have been proven effective in reducing distress and pain, topical anesthetic use before needle procedures is uncommon. However, there are limited studies in the existing literature comparing specifically liposomal lidocaine and tetracaine hydrochloride topical creams.SourceThis systematic review analyzed studies on the use of two anesthetic creams, Liposomal Lidocaine (Maxilene®) and Tetracaine hydrochloride (Ametop™), in children and adults undergoing a needle-related procedure. Databases searched: PubMed, CINAHL, ClinicalTrials. Only randomized controlled trials (RCT) and Controlled Clinical Trials (CCT) studies were included. Cochrane Collaboration's Risk of Bias assessment tool was used. Strictly minimally invasive procedures were included to standardize different skin needle interventions.Principal findingsOnly one study with 60 participants was available to be included in this review. No statistically significant difference was found in the mean pain score among both interventions. The outcomes of self-reported distress during cannulation and on HCP satisfaction were not reported. However, physiological characteristics associated with stress/anxiety and on cannulation success rate were reported and did not show statistical significance.ConclusionLittle to no evidence regarding the most efficient cream between liposomal lidocaine and tetracaine hydrochloride for pain management during needle-related procedures was found. Further studies, particularly RCT with larger sample sizes and standardized outcome measures, are needed to confirm the relative efficacy of either anesthetic cream.

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BackgroundThe rapid rise in intravitreal injections (IVIs) for vitreoretinal disorders underscores the need to optimize the procedure and support long-term patient compliance. Patient-reported pain and discomfort remain significant barriers to adherence. This systematic review evaluates the efficacy and safety of various local anesthetic methods for mitigating pain during IVIs.MethodsConducted in accordance with PRISMA guidelines, a comprehensive search of PubMed and Google Scholar was performed to identify English-language randomized controlled trials (RCTs). Eligible studies included patients aged 18 years and older receiving local anesthesia for IVIs, where pain was quantified using standard visual or oral analog scales (0-10 or 0-100).ResultsOur systematic review and meta-analysis included 14 RCTs comprising 1,300 patients. Analysis of topical lidocaine, tetracaine, and proparacaine formulations showed comparable analgesic efficacy, with all agents consistently achieving mild mean Visual Analog Scale (VAS) pain scores. No clinically meaningful superiority was identified among these primary agents (p = 0.62). Adjunctive therapies, particularly physical cooling (e.g., ice patches), demonstrated significant pain-reducing potential. While oxybuprocaine alone was less effective, its combination with physical cooling achieved the lowest mean pain scores. Meanwhile, topical NSAIDs showed limited additional benefit. Regarding safety, subconjunctival anesthetic injections were associated with a significantly higher incidence of subconjunctival hemorrhage and chemosis compared to topical applications, suggesting that topical strategies provide a favorable safety and efficacy profile for routine intravitreal injections.ConclusionIn conclusion, this systematic review and meta-analysis confirms that no single topical anesthetic is superior for intravitreal injections; all primary agents provide comparable, effective pain control. Topical application is safer than subconjunctival injection, which is associated with higher rates of hemorrhage and chemosis. Consequently, clinical protocols should standardize low-risk topical methods and incorporate simple non-pharmacological adjuncts, such as physical cooling, to optimize patient comfort.

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This review investigates commonly used local anesthetic agents and administration methods in diabetic retinopathy (DR) procedures, such as pan-retinal photocoagulation, intravitreal injections, and vitrectomy, focusing on pain control and procedural outcomes. A systematic review of PubMed was conducted to identify studies examining local anesthetic use in DR procedures. Studies were screened for relevance, full-text availability, and methodological rigor. Fourteen studies met the inclusion criteria and were evaluated for anesthetic type, dosage, application route, co-administration, and patient outcome. The Joanna Briggs Institute (JBI) critical appraisal tools were used to evaluate the methodological quality and risk of bias for each included study. Lidocaine emerged as the most frequently used anesthetic, effectively reducing pain and systolic pressure during pan-retinal photocoagulation and posterior vitrectomy. There was a statistically significant difference in the dosage of lidocaine (2.33 ± 1.00%) vs other alternative anesthetics (0.475 ± 0.05%) for surgical procedures used to treat DR. The topical application of lidocaine was preferred for its ease of administration and reduced risk of complications. Furthermore, povidone, an antiseptic agent, was frequently co-administered to disinfect the ocular surface and maintain aseptic conditions during intravitreal injections, reducing the risk of infection. Among the local anesthetics reviewed, lidocaine, administered topically or via injection, was most frequently studied and demonstrated effective procedural analgesia and favorable post-surgical outcomes. These findings suggest lidocaine is a suitable choice for DR procedures. Exploration of lidocaine's impact, consideration of patient medical history, and examination of a broader range of co-administered drugs are recommended for comprehensive insights into optimizing patient outcomes.

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During intensive and long-lasting treatments, short-term or emergency care, children often undergo minor needle-related procedures (ie, venepuncture, venous cannulation and puncture of central venous access ports). The use of topical analgesia topical analgesia before these procedures can reduce needle-related pain. There is, however, uncertainty about the type of local anaesthetic (ie, eutectic mixture of topical analgesia (EMLA) or tetracaine-containing creams (eg, Rapydan) that should be used.Therefore, a clinical practice guideline (CPG) was developed to establish a comprehensive, evidence-based overview and provide recommendations for clinical practice.A comprehensive multidisciplinary panel was assembled, comprising 16 professionals and patient representatives in the Netherlands. A systematic literature review was performed, and after dual appraisal of all articles, results were extracted and meta-analyses were performed. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to assess, extract and summarise the evidence. An in-person meeting was held to discuss the evidence, complete an evidence-to-decision framework and formulate recommendations.In total, ten randomised controlled trials comprising 1808 children formed the evidence base for the recommendations. We recommend the use of EMLA in children who need to undergo a minor needle-related procedure, with minimal application duration of 60 min (strong recommendation, very low-quality evidence). We suggest the use of tetracaine-containing creams only when rapid cannulation/puncture (ie, within 30-60 min) is required (weak recommendation, very low-quality evidence).In this CPG, we provide recommendations regarding the choice of local anaesthetic for needle-induced pain during minor procedures in children. With these recommendations, we aim to reduce procedural pain and thereby contribute to improving care for children.

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Panretinal photocoagulation (PRP) is a treatment for proliferative diabetic retinopathy (PDR). The procedure needs anesthetic agent to overcome the pain. Two widely used anesthetic agents are used in this study which are tetracaine 0.5% eyedrops and lidocaine 2% gel. This study aimed to compare the effectivity and efficacy of both anesthetic agents. A prospective randomized controlled trial was done to 40 eyes divided into two groups, group A was treated with tetracaine 0.5% eyedrop and group B with lidocaine 2% gel. Pain score was obtained subjectively from the patient and recorded during four stages of procedure. The results showed that the mean age was 56.5 years in Group A and 53.20 years in group B. Average procedure duration was 8.7 minutes in group A and 9.35 minutes in group B. Average 5 minutes pain level was 3.05 and 2.10 in group A and B consecutively. Average 10 minutes pain level was 2.65 and 2.45 in group A and B consecutively. Average during procedure pain level was 2.70 and 3.40 in group A and Group B, and average post procedure pain level was 1.20 in Group A and 1.55 in Group B. There was no significant difference between both groups’ parameters. In conclusion, the use of both agents is interchangeable and shows no differences in efficacy and effectivity. Keywords: panretinal photocoagulation; proliferative diabetic retinopathy; anesthetic agent; tetracaine; lidocaine

Abstract licence: CC BY-NC 4.0

Purpose: To compare the efficacy and safety of a novel ophthalmic anesthetic, chloroprocaine 3% gel to tetracaine 0.5% eye drops in patients undergoing cataract surgery with phacoemulsification. Methods: This was a prospective, randomized, multicenter, active-controlled, masked-observer, parallel group competitive equivalence study. The study comprised 338 patients having routine cataract extraction by clear corneal phacoemulsification, randomized to receive 3 drops of chloroprocaine gel (n = 166) or tetracaine eye drops (n = 172) before surgery. The primary objective of the study was to assess the equivalence of chloroprocaine gel to tetracaine eye drops as proportion of patients with successful ocular surface anesthesia, without any supplementation just before intraocular lens implantation. Safety measurements were pain, irritation, burning, stinging, photophobia, and foreign body sensation, graded by the patient and objective ocular signs. Results: Equivalence was demonstrated, with a somewhat higher success rate of chloroprocaine gel: 152/166 (92.0%) chloroprocaine versus 153/172 (90.5%) tetracaine patients achieved ocular surface anesthesia with no supplementation. Difference in proportions was 1.5% confidence interval [95% CI: (-3.6 to 6.6)] and 90% CI fell within (-10 to 10). Mean onset of anesthesia was 1.35 ± 0.87 min for chloroprocaine and 1.57 ± 1.85 for tetracaine (P = 0.083). Mean duration of anesthesia was 21.57 ± 12.26 min for chloroprocaine and 22.04 ± 12.58 for tetracaine (P = 0.574). No treatment emergent adverse events related to chloroprocaine were reported and no relevant findings related to local tolerance or vital signs were observed in both arms. Conclusions: Results obtained from the present cataract study demonstrated that chloroprocaine 3% ophthalmic gel is safe and effective, representing a valid alternative in ocular topical anesthesia. Clinical Trial Registration number: NCT04685538.

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PurposeTo evaluate the efficacy and safety of topical tetracaine eye drops as a preemptive skin anesthetic during botulinum toxin type A injection in blepharospasm patients.Patients and methodsA double-blind, split-face randomized controlled trial was conducted in 17 participants diagnosed with benign essential blepharospasm between November 2023 and July 2024. Each patient received randomized treatment on opposite sides of the face: a cotton pad soaked with 5 mL of 0.5% tetracaine ophthalmic solution on one side and normal saline solution on the other, for 30 minutes. The cotton pad temperature, the injection dose, and the techniques were controlled on each side. A single neuro-ophthalmologist performed the injection. Pain scores were immediately rated after the injection, using a numeric rating scale from 0 to 10. Jankovic rating scale and complications were assessed on the day of injection, then 1 month and 3 months after injection.ResultsThe numeric rating scale on the side receiving topical 0.5% tetracaine eye drops was significantly lower than the side receiving topical normal saline solution (4.56 ± 2.63 vs 6.71 ± 2.54, p = 0.013). There were no significant differences in the Jankovic rating scale, cotton pad temperature, bleeding at the injection site, and other complications between the two groups.ConclusionThe application of 0.5% tetracaine ophthalmic solution as a preemptive topical skin anesthesia can decrease pain during botulinum toxin type A injection for blepharospasm patients without affecting the efficacy or producing any significant complications.

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