Lidocaine Iontophoresis for Topical Anesthesia Before Dermatologic Procedures in Children: A Randomized Controlled Trial

Abstract

Local anesthesia by injection in pediatric patients undergoing dermatologic procedures is not well received because of the pain of injection and the fear of needles. Lidocaine iontophoresis is a method of topical anesthesia where lidocaine is driven into the skin under the influence of electric current. We performed a prospective double-blind, placebo-controlled evaluation of iontophoresis of 2% lidocaine with 1:100,000 epinephrine. Sixty children requiring dermatologic procedures were enrolled (50 shave biopsy, 7 curettage, 2 injection, 1 punch biopsy). Twenty-nine of 31 patients in the lidocaine group versus 2 of 29 placebo patients required no supplemental anesthesia (p < 0.001). The pain reported by the patients on the Oucher pain scale subsequent to the procedure was significantly lower in the lidocaine group (p < 0.001). Investigators and parents also rated pain lower in the lidocaine group (p < 0.001). Blanching and/or erythema occurred in 58 of 60 patients, but resolved within 1 hour in all patients. There were no other adverse events. Lidocaine iontophoresis is a safe and effective method of topical anesthesia prior to dermatologic procedures in children.

Iontophoresis-Infused Deep Topical Anesthesia and Injectable Local Anesthesia for Dental Procedures Among Pediatric Patients: Performances and Consequences

“…The current study is a forerunner to show the application of the iontophoresis procedure for more invasive treatments like extraction and pulpectomies. The study established the duration of application as 4-6 minutes for children, in agreement with the previous studies, which range from 2-15 minutes for adults [6,13] (Figure 5).…”

Optimizing pediatric periprocedural pain management part I—Evolving ethics and topical anesthetics

“…64 Several studies have documented iontophoresis as a well-toleratedand effective method of topical anesthesia in minor dermatologic procedures and intravenous cannulation. 65,66 Current limitations of iontophoresis include higher cost, anatomic location limitations, and bulky devices that are not readily accessible to most clinicians.…”

Effect of Modulated Alternating and Direct Current Iontophoresis on Transdermal Delivery of Lidocaine Hydrochloride

“…Studies have also reported that iontophoresis facilitates the transport of lidocaine molecules into the skin under the influence of electric current and can provide topical anesthesia of intact skin within 5–15 min [14]. Lidocaine iontophoresis has also been found to be effective in reducing the pain associated with venous cannulation in patients [15].…”