Eutectic lidocaine/prilocaine 5% cream and patch may provide satisfactory analgesia for excisional biopsy or curettage with electrosurgery of cutaneous lesions. A randomized, controlled, parallel group study

A K Gupta, R G Sibbald
Journal of the American Academy of Dermatology 1996, 35 (3): 419-23

BACKGROUND: Needle puncture and infiltrational anesthesia is generally required for minor cutaneous surgical procedures and may be associated with anxiety, fear, discomfort, and pain. The use of topical anesthetics such as eutectic lidocaine/prilocaine 5% cream may provide an alternative means of delivering anesthesia.

OBJECTIVE: Our purpose was to evaluate the effectiveness of eutectic lidocaine/prilocaine 5% cream applied under either occlusive adhesive dressing (Tegaderm) or patch formulation in providing analgesia for removal of lesions 40 mm long or shorter on the trunk or extremities; removal was effected by excisional biopsy or curettage with electrosurgery.

METHODS: One hundred six patients (58 men, 48 women), 22 to 90 years of age, participated in this open-labeled, randomized, controlled, parallel group study. Patients were randomly assigned to receive either 2.5 to 5 gm of cream applied under an occlusive dressing or a 1.0 gm single-dose-unit patch. The topical anesthetic was removed 2 to 3 hours after application and just before surgery. This area was then tested for analgesia to pinprick. If analgesia was insufficient to the pinprick or during the surgical procedure, lidocaine infiltration was given. Patients rated the pain of the surgical procedure on a 100 mm visual analog scale.

RESULTS: After application times of 110 to 180 minutes, effective anesthesia was achieved in 87% of subjects. Treatment with the patch was equal to the cream/Tegaderm dressing in reducing pain experienced during surgery. No significant difference was found between the adhesiveness of the two dressings; however, the patch was easier to apply than the cream/ Tegaderm. No unexpected adverse events were observed.

CONCLUSION: For minor skin surgical procedures involving excisional biopsy or curettage with electrosurgery, eutectic lidocaine/prilocaine 5% cream/Tegaderm and patch formulations were equally effective and provided effective anesthesia in 87% of subjects. The patch formulation may be more convenient for self-application.

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