Topical anesthesia

Abstract

Topical anesthetics are being widely used in numerous medical and surgical sub-specialties such as anesthesia, ophthalmology, otorhinolaryngology, dentistry, urology, and aesthetic surgery. They cause superficial loss of pain sensation after direct application. Their delivery and effectiveness can be enhanced by using free bases; by increasing the drug concentration, lowering the melting point; by using physical and chemical permeation enhancers and lipid delivery vesicles. Various topical anesthetic agents available for use are eutectic mixture of local anesthetics, ELA-max, lidocaine, epinephrine, tetracaine, bupivanor, 4% tetracaine, benzocaine, proparacaine, Betacaine-LA, topicaine, lidoderm, S-caine patch™ and local anesthetic peel. While using them, careful attention must be paid to their pharmacology, area and duration of application, age and weight of the patients and possible side-effects.

Rare Yet Devastating Complications of Circumcision

“…Local analgesia, due to the fact that they are topical, has much fewer self-limiting complications in comparison to the more invasive nerve block. While infrequent, burning, or stinging at the administration site, allergic reaction to the local anesthetic, skin discoloration, skin swelling, and neuritis might occur [14]. On the other hand, a dorsal penile nerve block is more invasive; the procedure of nerve block is itself painful.…”

Local Anesthesia

“…Their delivery and effectiveness can be enhanced by using free bases, by increasing the drug concentration, lowering the melting point, by using physical and chemical permeation enhancers and lipid delivery vesicles. Topical anesthetics are also able to penetrate mucosal surfaces, such as the mouth, genitals, and conjunctiva more easily than through a keratinized surface because of the absence of a stratum corneum [37].…”

Efficacy and safety of a triple active sore throat lozenge in the treatment of patients with acute pharyngitis: Results of a multi-centre, randomised, placebo-controlled, double-blind, parallel-group trial (DoriPha)

“…In the majority of cases, the infection that causes pharyngitis is initially viral in nature 1,2 and may be superinfected by bacteria due to inadequate use of antibiotics and disturbed microflora [3][4][5][6] or diverse viral mechanisms which include disruption of the epithelial barrier, upregulation of adhesion proteins, production of viral factors, and dysfunction of immune system components. 1,2,[7][8][9][10] Except for streptococcus infections occurring in approximately 15% of patients and haemorrhagic fever who clearly need systemic antibiotic regimes first line 11 in non-streptococcal, viral pharyngitis treatment is usually symptomatic addressing relief in pain: Lozenges and sprays are available with a variety of active ingredients for treating sore throat, but only one with a triple combination of synergistically active ingredients 12 : Dorithricin ® lozenges contain: (a) Benzocaine, a local anaesthetic sodium channel blocker with analgesic activity which confers a fast and sustained pain relief 13 (b) Benzalkonium chloride, a biocide with antimicrobial and antiviral activity [14][15][16][17] (c) Tyrothricin, a small, cationic, amphiphilic, antimicrobial peptide (AMP), a naturally occurring antimicrobial non-resorbed agent with a broad spectrum. As part of the innate immune system of vertebrates, AMPs have direct antimicrobial function, acting as mediators of inflammation and their antimicrobial spectrum covers Gram-positive and -negative bacteria, in case of superinfection, as well as fungi and certain viruses.…”