Transient hyperaemic response to assess vascular reactivity of skin: effect of topical anaesthesia

Wiles, M. D.; Dickson, Edward A; Moppett, I. K.

doi:10.1093/bja/aen164

Cited by 10 publications

(15 citation statements)

References 20 publications

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“…Several studies have examined the effects of topical EMLA application. Our findings that EMLA applied for 60 min has no effect on skin blood flow are consistent with the majority of studies [2–4, 15, 19–21]. In addition, EMLA had no effect on vascular reactivity in our study, which is at odds with some published work, where vascular reactivity has been assessed with methods other than the transient hyperaemic response including the veno‐arteriolar response [22], arterial occlusion by tourniquet [20] and electrical stimulation [3].…”

Section: Discussionsupporting

confidence: 89%

“…The methodology of the transient hyperaemic response test was similar to that described in previous studies [14, 15, 17]. Brief arterial occlusion was achieved by manual compression of the brachial artery for 20 s, followed by immediate release.…”

Section: Methodsmentioning

confidence: 99%

“…Our primary hypothesis was that the application of a Rapydan plaster for 30 min would cause a greater increase in blood flow flux and a greater reduction in hyperaemic response than the application of Ametop for 60 min, by an alteration in vascular tone. The application of EMLA cream for 60 min has been shown to have no net effect on skin blood flow‐flux [15], so this was chosen as an active control cream.…”

mentioning

confidence: 99%

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The effect of a new topical local anaesthetic delivery system on forearm skin blood flow reactivity*

Wiles¹,

Dobson²,

Moppett

2009

Anaesthesia

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SummaryDifferent topical local anaesthetics have varying effects on skin blood flow and vascular reactivity. We compared the vasoactive properties of Rapydan Ò , a new topical local anaesthetic, with those of Ametop TM and EMLA TM creams in 20 healthy volunteers. Blood flow and vascular reactivity in the forearm skin were assessed by laser Doppler flowmetry and the transient hyperaemic response ratio respectively, before and after the application of EMLA (for 60 min), Ametop (for 30 and 60 min) and Rapydan (for 30 min). Application of EMLA had no effect on skin blood flow (median (IQR The use of local anaesthesia may be beneficial due to a possible increase in local blood flow. The evidence for the effects of local anaesthetics on blood flow and vessel reactivity is incomplete and contradictory, and the effects seen may depend on the drug used and the vessels studied [1][2][3][4][5]. Tetracaine (Ametop TM , Smith & Nephew Healthcare Ltd, Hull, UK) and eutectic mixture of 2.5% lidocaine and 2.5% prilocaine (EMLA TM ; AstraZeneca Ltd, London, UK) are widely used topical agents that provide anaesthesia of the superficial and deep skin layers. A medicated plaster containing lidocaine and tetracaine (Rapydan Ò ; EUSA Pharma (Europe) Ltd, Oxford, UK) is now available that can produce topical anaesthesia of the skin within 30 min [6,7]. The plaster is oval in shape, measuring approximately 80 · 60 mm, with an adhesive edge (allowing the plaster to be applied topically to the skin) surrounding a central area containing the active drug ingredients. This central area also contains a heat releasing component that warms the skin up to a maximum temperature of 40°C (with a mean temperature of 26-34°C) [8,9], theoretically enhancing drug absorption. The effect of Rapydan drug constituents and the heated plaster on the vascular reactivity of skin has not been established.Vascular reactivity can be altered by a variety of disease states including hypertension [10], diabetes mellitus [11] and sepsis [12]. Alterations in skin vascular reactivity may help predict responses in other more clinically significant vascular beds. Within the skin, vascular reactivity has been assessed using laser Doppler flowmetry and the hyperaemic response to a variety of stimuli including acetylcholine iontophoresis, heat and ischaemia. The transient hyperaemic response to 20 s of arterial occlusion allows an easily repeatable, non-invasive assessment of vascular reactivity to be made [13,14].Our primary hypothesis was that the application of a Rapydan plaster for 30 min would cause a greater increase in blood flow flux and a greater reduction in hyperaemic response than the application of Ametop for 60 min, by an alteration in vascular tone. The application of EMLA cream for 60 min has been shown to have no

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Section: Discussionsupporting

confidence: 89%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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The effect of a new topical local anaesthetic delivery system on forearm skin blood flow reactivity*

Wiles¹,

Dobson²,

Moppett

2009

Anaesthesia

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“…In addition, the cost per treatment with EMLA is significantly higher than with vapocoolants. Finally, there are rare side effects associated with EMLA, including irritation to mucous membranes, hemorrhages and tissue necrosis for those patients with small vessel disease related to hypertension, diabetes mellitus and/or sepsis (23,24).…”

Section: Discussionmentioning

confidence: 99%

Microcirculatory effect of topical vapocoolants

et al. 2015

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“…Local anaesthetic formulations like EMLA cream containing prilocaine, , which is known to have a vasoconstrictor effect, resulting in epidermal blanching (11). However, after 60 minutes of application, EMLA cream does not cause a significant change in local skin blood flow (12) and it does not interfere with the success rate at the first attempt of venepuncture or intravenous cannulation (13). On the other hand, tetracaine is known to cause local vasodilatation, but the warm patch formulation, together with lidocaine, has a vasodilatatory effect that is less pronounced than other formulations that just contain tetracaine (14).…”

Section: Accepted Articlementioning

confidence: 99%

First‐time success with needle procedures was higher with a warm lidocaine and tetracaine patch than an eutectic mixture of lidocaine and prilocaine cream

et al. 2017

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Accepted ArticleThis article is protected by copyright. All rights reserved. Aim: More than 50% of children report apian during venipuncture or intravenous cannulation and using local anaesthetics before needle procedures can lead to different success rates. This study examined how many needle procedures were successful at the first attempt when children received either a warm lidocaine and tetracaine patch or an eutectic mixture of lidocaine and prilocaine (EMLA) cream. Methods:We conducted this multicentre randomised controlled trial at three tertiary-level children's hospitals in Italy in 2015. Children aged 3-10 years were enrolled in an emergency department, paediatric day hospital and paediatric ward and randomly allocated to receive a warm lidocaine and tetracaine patch or EMLA cream. The primary outcome was the success rate at the first attempt. Results:The analysis included 172 children who received a warm lidocaine and tetracaine patch and 167 who received an EMLA cream. The needle procedure was successful at the first attempt in 158 children (92.4%) who received the warm patch and in 142 children (85.0%) who received the cream (p=0.03). The pain scores were similar in both groups. Conclusion:This study showed that the first-time needle procedure success was 7.4% higher in children receiving a warm lidocaine and tetracaine patch than EMLA cream. Accepted ArticleThis article is protected by copyright. All rights reserved.Keywords: eutectic mixture of lidocaine and tetracaine cream; local anaesthetic; needle procedure; procedural success rate; warm lidocaine and tetracaine patch Key notes:• Applying local anesthetics may influence success rates in children undergoing painful needle procedures.• We compared how many needles were inserted at the first attempt when children received a warm lidocaine and tetracaine patch or an eutectic mixture of lidocaine and prilocaine (EMLA) cream.• The three Italian hospitals who took part reported that the success rate was higher in children treated with the warm patch (92.4%) than the cream (85.0%). AbbreviationsARR, absolute risk reduction; CI, confidence intervals; EMLA, eutectic mixture of lidocaine and tetracaine; IQR, interquartile ranges; NNT, number need to treat; RR, relative risks

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Transient hyperaemic response to assess vascular reactivity of skin: effect of topical anaesthesia

Abstract: The application of topical Ametop decreases microvascular tone and vasoreactivity of the forearm skin in healthy volunteers.

Cited by 10 publications

References 20 publications

The effect of a new topical local anaesthetic delivery system on forearm skin blood flow reactivity*

The effect of a new topical local anaesthetic delivery system on forearm skin blood flow reactivity*

Microcirculatory effect of topical vapocoolants

First‐time success with needle procedures was higher with a warm lidocaine and tetracaine patch than an eutectic mixture of lidocaine and prilocaine cream

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