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.

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We performed a systematic review and network meta-analysis (NMA) to assist clinicians in determining the optimal patient-specific method of analgesia during radial artery puncture by comparing radial artery puncture procedural pain. We included randomized controlled trials that assessed the prophylactic efficacy of local anesthesia for radial artery puncture-associated pain. We searched the Medical Literature Analysis and Retrieval System Online in January 2023, the Cochrane Central Register of Controlled Trials in January 2023, the Excerpta Medica Database in December 2022, the World Health Organization International Clinical Trials Platform Search Portal in January 2023, and ClinicalTrials.gov in January 2023. We synthesized the pain scores (0-100 scale) using the frequentist random-effects NMA model. We evaluated the confidence in each outcome using the CINeMA tool (https://cinema.ispm.unibe.ch/). We conducted an NMA of 1,619 patients across 14 studies on pain scores during radial artery puncture-related procedures for 12 interventions. Compared with placebo, mepivacaine infiltration and lidocaine spray probably reduce pain (mean difference (MD): -47.67, 95% confidence interval (CI): -61.45 to -33.89, confidence rating (CR): moderate; MD: -27.38, 95% CI: -37.53 to -17.22, CR: moderate). Of the 32 studies included, none reported systemic adverse events, such as anaphylaxis or local anesthetic systemic toxicity, or severe local adverse events. In conclusion, mepivacaine infiltration and lidocaine spray probably reduce the pain associated with radial artery puncture more than other local anesthesia.

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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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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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BackgroundThe injection of local anesthetics, an extremely painful procedure, leads to a reduction of patients' acceptance.ObjectiveTo investigate the efficacy and adverse reactions of 4% tetracaine gel (TG) and lidocaine-prilocaine cream (LPC) on reducing the local anesthetic injection pain for upper eyelid blepharoplasty.MethodsSixty participants were equally divided into three groups. Each patient in two treatment groups was assigned a pair of eutectic mixture of local anesthetics (EMLA) and 4% TG, and the blank control group did not receive any topical anesthetic. The primary outcome was the pain score associated with anesthetic injection. The secondary outcomes included the local cutaneous reactions and eyelid edema in 24 h postoperatively.ResultsThe NRS score in the control group was 6.65 ± 1.60, in the 4% TG and EMLA sides of 5.75 ± 1.62 and 6.25 ± 1.48 in group A, without statistically significant (p = 0.334, 0.067, respectively). While in group B, the injection pain scores in 4% TG and EMLA sides were 4.65 ± 1.66 and 5.5 ± 1.73 (p ConclusionIn comparison to LPC, 4% TG showed a stronger anesthetic effect on reducing injection pain after 60-minute application. It also generally presented a higher frequency of cutaneous reactions but didn't affect the eyelid edema 24 h postoperatively.Trial registrationThis study was registered at chictr.org (the first registration date is 03/04/2023, and the registration number is ChiCTR2300070153).

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