Lidocaine-prilocaine Cream Research Articles

Local Lidocaine–Prilocaine for Immunisation in Infants

Introduction: Lidocaine–prilocaine cream effectively reduces vaccination pain, improving vaccination adherence and advocating for its routine use in healthcare settings. Methods: This review used PRISMA guidelines and the PICOT format to structure the analysis. The focus was on paediatric patients aged 0–12 months requiring intramuscular vaccinations, comparing the application of lidocaine–prilocaine cream to other interventions or no treatment. Data sources included MEDLINE, PUBMED, EMBASE, BMC, Research GATE, and Cochrane Library. Studies were selected based on predefined inclusion and exclusion criteria, with data extracted regarding participant demographics, pain assessment scales, and study conclusions. The Cochrane Risk of Bias Tool assessed study quality, while statistical analyses evaluated the effectiveness of the intervention. Results: Fifty studies were identified, with nine ultimately included in the analysis, involving 704 participants. The primary outcome was the effectiveness of lidocaine–prilocaine cream in reducing pain after vaccinations. Results showed a significant mean difference of −1.719 in pain scores for infants treated with lidocaine–prilocaine compared to those receiving other interventions. Behavioural indicators, such as crying duration and latency to the first cry, favoured the lidocaine–prilocaine group. Conclusions: Lidocaine–prilocaine cream effectively reduces vaccination pain, supporting its routine use in healthcare settings. Engaging parents can enhance vaccination adherence. Training healthcare professionals on lidocaine–prilocaine cream application and pain scales is vital for improving patient satisfaction. Further research is needed to evaluate the long-term effects of lidocaine–prilocaine cream on vaccination experiences and infant behavioural health.

Topical lidocaine for pessary removal and reinsertion pain reduction: a randomized clinical trial

BackgroundVaginal pessaries are an inexpensive non-surgical treatment for pelvic organ prolapse and stress urinary incontinence. Pessary maintenance includes periodic removal, cleaning, and reinsertion, which can be painful. Lidocaine-prilocaine cream has been shown to significantly reduce pain during pessary maintenance exams. In some practices, Lidocaine HCl 2% jelly may be more readily available and serve as an alternative to lidocaine-prilocaine cream. However, the effect of Lidocaine HCl 2% jelly use during pessary maintenance exams has not been tested. ObjectiveTo estimate the effect of Lidocaine HCl 2% jelly versus lubricating jelly on pain at the time of office pessary removal and reinsertion. Study DesignThis study is a single-blind, randomized clinical trial among patients presenting to a urogynecology office at a tertiary care center. Participants were randomized to the application of 5cc of Lidocaine HCl 2% jelly or a water-based lubricating jelly five minutes before pessary removal. Visual analog scale pain scores were collected from the participants at baseline, at pessary removal, and at pessary reinsertion. The primary outcome was the visual analog scale pain score at the time of pessary removal. A sample size of 33 per group (n=66) was planned to estimate an absolute mean difference in visual analog pain scale of 2.05 cm at the time of pessary removal. ResultsBetween September 2022 and June 2023, 192 women were screened, and 66 were enrolled. Thirty-three participants were randomized into the lubricating jelly group and 33 participants were randomized into the Lidocaine HCl 2% jelly group. The two groups were similar in baseline characteristics. Most participants were postmenopausal, using vaginal estrogen, wearing a 70 mm ring pessary with support for pelvic organ prolapse, and reported being very satisfied with the pessary. Other pessaries worn included ring without support, incontinence rings with and without support, Gellhorn, and donut. The pessary sizes ranged from 51 mm to 96 mm. There was no significant difference in pessary type and size between groups. Visual analog scale pain scores at pessary removal were low in both groups: 3.23±3.00 cm in the lubricating group and 2.66±2.77 cm in the lidocaine group. After adjusting for baseline pain, there was no significant difference in pain at pessary removal between the lidocaine jelly and the lubricating jelly groups (mean difference=-0.56 cm, 95% CI: -1.97 to 0.85; p=0.44). Despite no significant difference in visual analog scale pain scores, 71.2% of participants reported a desire for numbing jelly at future pessary examinations. ConclusionPain during pessary removal and reinsertion is low. Compared to lubricating jelly, lidocaine jelly did not further reduce pain during pessary examinations.

Effect of Lidocaine-prilocaine Cream on Using CPAP Mask Amongst Patients Undergone PAPtitration Study for Obstructive Sleep Apnea: A Randomized Controlled Trial Study.

Despite the high efficacy of using Continuous positive airway pressure (CPAP) in reversing upper airway obstruction in obstructive sleep apnea (OSA), the efficiency of this treatment is limited due to the low adherence. Mask pressure is suggested to play a significant role in adherence. In this study, we intend to investigate the effect of Lidocaine-prilocaine cream CPAP mask on pressure sensation. In this study, 75 patients referred to CPAP titration were divided into three groups. In groups one and two, Lidocaine-prilocaine cream and Petroleum jelly were used respectively. The third group had no intervention. VAS discomfort immediately (VAS0), after 15min (VAS15), and the next day (VAS all) in three groups were compared. VAS0, VAS15, and VAS all were not significantly different among the three groups (P > 0.05). Among participants with VAS0 above 5, VAS15 was significantly lower in intervention groups than the control group (P < 0.05). This study shows that both Petroleum jelly and Lidocaine-prilocaine cream can be used for decreasing pressure sensation during CPAP titration among patients who suffer excessive facial discomfort immediately after putting on a CPAP mask.

The Effect of Lidocaine-Prilocaine Cream Combined with or Without Remimazolam on VAS and APAIS Anxiety Score in Patient Undergoing Spinal Anesthesia.

This study aimed to investigate patients' expectative pain of spinal anesthesia puncture and anxiety pre-anesthesia, and to examine the effect of lidocaine-prilocaine cream and remimazolam prior to spinal anesthesia puncture on pain relief and anxiety release. Patients undergoing spinal anesthesia were divided into control, lidocaine-prilocaine cream, and lidocaine-prilocaine cream with remimazolam groups. A questionnaire consisting of The Amsterdam Preoperative Anxiety and Information Scale (APAIS) and patient's concerns and Visual Analog Scale (VAS) was used to evaluate patient's anxiety and pain. The primary outcomes were differences in VAS and anxiety scores. Patient's spinal anesthesia-related concerns, advent events and hemodynamic index were also recorded. The expected spinal anesthesia puncture pain was 5.34±0.27 and anxiety scores before spinal anesthesia was 10.88 ± 0.64. A statistically significant positive correlation of 31.3% was detected between VAS and APAIS scores (r = 0.313; P=0.003). The VAS score at the time of puncture decreased by 29.7% (3.78±0.40, P=0.001) in lidocaine-prilocaine cream group and 29.2% (3.75±0.39, P=0.001) in lidocaine-prilocaine cream with remimazolam group compared with the expected VAS score. Lidocaine-prilocaine cream combined with or without remimazolam reduced the percentage of moderate pain (21.4% and 31.3% vs 50.0%, P=0.0001) and increased mild pain (60.7% vs 59.4% vs 22.7%, P=0.03). Anxiety score in lidocaine-prilocaine cream group was reduced by 2.84 (8.04±0.76 vs 10.88 ± 0.46, P=0.05) when compared with pre-anesthesia. Concerns about postoperative pain (P=0.03) and fear of the needle or intervention (P=0.000) both decreased post-anesthesia among groups. Approximately half of the patients scheduled for spinal anesthesia experienced a moderate level of preoperative anxiety. The patient's pain expectation from the spinal anesthesia puncture was moderate, which was higher than the actual pain. Lidocaine-prilocaine cream with or without remimazolam sedative before spinal anesthesia puncture reduced the patient's pain and anxiety scores after surgery.

Comparison of dorsal penile nerve block alone and in combination with lidocaine–prilocaine cream in neonates undergoing circumcision: a randomized controlled study

BackgroundSuboptimal neonatal circumcision analgesia causes a significant stress response. There is continued search for more effective analgesia for neonatal circumcision. We aimed to determine whether lidocaine–prilocaine cream (LPC) prior to...

Reducing tumescent anesthetic injection pain by topical anesthesia pretreatment among patients undergoing endovenous radiofrequency ablation of varicose veins: A double-blind randomized controlled trial.

Tumescent anesthesia frequently causes the intraoperative and postoperative pain during radiofrequency ablation (RFA) of varicose veins. We have to find a way to reduce pain caused by these injections. This randomized controlled trial investigated the effectiveness of topical anesthesia pretreatment (TAP) on relieving needle puncture pain during administration of tumescent anesthesia among patients undergoing RFA of varicose veins. Eligible patients treated with RFA were recruited and randomized to either application of TAP with lidocaine-prilocaine cream (EMLA) or water-based cream (placebo). The primary outcome was patient described pain scores on the visual analogue scale (VAS) at different time points during the procedure. Secondary outcomes were technical success rate, complications, satisfaction level, expense, and extra analgesia use. Sixty-two patients were randomized: 32 to EMLA and 30 to placebo. Both groups had comparable baseline demographics, CEAP classification, and Venous Clinical Severity Score (VCSS). Less tumescent anesthetic needle puncture pain was found in the EMLA group (22 ± 7 vs 42 ± 8, p < .01). Pain scores of other time points were equivalent. There was less pain in EMLA pretreated area compared to non-pretreated area in the same patient during needle puncture (22 ± 7 vs 45 ± 7, p < .01), and similar phenomena did not appear in the placebo group. There was no statistical difference in complications, satisfaction level, expense, and technical success between the two groups. And no extra analgesia was used in all patients. We recommend the routine use of TAP to reduce the needle puncture pain during tumescent anesthesia in RFA of lower extremity varicose veins.

EMLA (lidocaine–prilocaine) cream for pain relief during hysterosalpingography: a systematic review and meta-analysis of randomised placebo-controlled trials

We systematically investigated the efficacy and safety of EMLA (5% lidocaine–prilocaine cream) versus placebo for pain relief among infertile patients undergoing hysterosalpingography (HSG). We screened four databases from inception until 25 November 2020. We included only randomised placebo-controlled trials (RCTs) and assessed their risk of bias. The main efficacy outcomes included safety and pain scores during the different stages of HSG. The pooled outcomes were summarised as mean difference (MD) with 95% confidence interval (CI). Three RCTs were included, comprising 258 patients (131 and 127 patients received EMLA and placebo, respectively). All RCTs revealed an overall low risk of bias. EMLA significantly reduced pain perception during cervical instrumentation of tenaculum and cannula (MD = −1.53, 95% CI [−2.59, −0.47], p = 0.005) and at 24 h after completion of HSG (MD = −1.30, 95% CI [−2.57, −0.03], p = 0.04). Despite EMLA decreased pain perception during the other procedural stages of HSG, the differences were not statistically significant compared with placebo. EMLA was safe and free of local and systemic adverse reactions. This meta-analysis advocates that topical application of 5% EMLA cream is safe and correlates with decreased pain perception during HSG, particularly during the cervical instrumentation step and at 24 h after HSG completion.

Different interventions for preventing postoperative catheter-related bladder discomfort: a systematic review and meta-analysis.

Catheter-related bladder discomfort (CRBD) is a common complication of intraoperative urinary catheterization. Various studies have evaluated the efficacy of different interventions in postoperative CRBD. The present review was performed to assess the efficacy of these interventions. PubMed, Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) databases were systematically searched to identify randomized controlled trials (RCTs) investigating the efficacy of different drugs for the prevention of postoperative CRBD. This review evaluated the incidence and severity of CRBD after different interventions at 0, 1, 2, and 6h postoperatively. Forty-five studies including 31 different drugs were analyzed. Eleven drugs were investigated in more than two RCTs, of which dexmedetomidine, gabapentin, tolterodine, tramadol, ketamine, nefopam, oxybutynin, pregabalin, and pudendal nerve block (PNB) generally showed significantly higher efficacy than controls postoperatively. Solifenacin only showed significant efficacy compared with the control at 0h, and intravenous lidocaine only showed significant efficacy compared with the control at 6h. There were insufficient trials to draw conclusions regarding atropine, butylscopolamine, chlorpheniramine, clonidine, darifenacin, diphenhydramine, glycopyrrolate, intravesical bupivacaine, ketamine-haloperidol, pethidine-haloperidol, ketorolac, lidocaine-prilocaine cream, magnesium, hyoscine n-butyl bromide, oxycodone, paracetamol, parecoxib, trospium, resiniferatoxin, or amikacin. However, all but pethidine-haloperidol and chlorpheniramine showed some efficacy at various time points compared with controls. This review suggests that dexmedetomidine, gabapentin, tolterodine, tramadol, ketamine, nefopam, oxybutynin, pregabalin, and PNB are effective in preventing postoperative CRBD. Considering the efficacy and adverse effects of all drugs, dexmedetomidine and gabapentin were ranked best.

Comparing the Effect of Lidocaine-Prilocaine Cream and Infiltrative Lidocaine on Overall Pain Perception During Thoracentesis and Abdominocentesis: A Randomized Clinical Trial.

BackgroundAcute pain management is a core ethical commitment to medical practice. However, there is evidence to suggest that sometimes infiltrative lidocaine (IL) is not used prior to thoracentesis and abdominocentesis due to the belief that two needles cause greater pain than one. However, topical anesthetics like lidocaine-prilocaine cream (LPC) are painless, easy to use, and have less systemic side effects. Therefore, LPC can be a suitable substitute for medical procedures.ObjectivesThis study was designed to compare the analgesic effects of LPC with IL in thoracentesis and abdominocentesis.MethodsPatients were divided into two study groups, including individuals seeing a physician for a thoracentesis (N = 36) and those seeing a physician for an abdominocentesis (N = 33). Patients were randomly assigned to the IL (N = 35) or LPC (N = 34) groups for diagnostic and/or therapeutic purposes. The IL group received 100 mg of 2% lidocaine 5 minutes prior to their procedure, whereas the LPC group received 2.5 g of lidocaine-prilocaine cream. The cream was spread over a 20 - 25 cm2 area and occluded with dressing plaster for 30 minutes prior to the procedure. In both study groups, the thoracentesis and abdominocentesis were ultrasound-guided.ResultsThe findings suggest a non-significant difference between overall pain perception in LPC and IL groups generally, as well as specifically in abdominocentesis and thoracentesis groups. Furthermore, the result remained the same after controlling for confounding variables. The number of attempts to perform successful abdominocentesis was significantly higher in the LPC than IL (P-value = 0.003) group but was not significant in the thoracentesis group (P-value = 0.131). The level of patient satisfaction in the LPC and IL groups were not significantly different (P-value > 0.05).ConclusionsOverall, LPC appears to be an appropriate alternative to IL in reducing pain during thoracentesis and abdominocentesis, but it seemed to increase unsuccessful medical procedure attempts.

Topical anaesthesia as an adjuvant to local anaesthetic injection in open trigger digit release: a randomized controlled trial.

We conducted a randomized controlled trial to compare pain scores and patient satisfaction between topical anaesthetic cream (5% lidocaine-prilocaine cream) versus placebo cream, applied approximately 90 minutes before local anaesthetic injection for open trigger digit release. One hundred participants were enrolled and randomly allocated into the two groups between May 2019 and February 2020. The visual analogue pain scores and satisfaction scores were measured. Most participants were female with Quinnell Grade 2-3 trigger digits. The pain scores during needle injection, local anaesthetic infiltration, the overall pain and satisfaction scores had no statistically significant differences between groups. There was no correlation between duration of topical anaesthetic drug application and pain scores. Subgroup analysis did not show significant differences in pain scores between genders. No complications were found during the study period. The topical anaesthetic drug was ineffective to use on the palmar skin during open trigger digit release surgery.Level of evidence: II.

Topical lidocaine-prilocaine cream versus rectal meloxicam suppository for relief of post-episiotomy pain in primigravidae: A randomized clinical trial

ObjectivesTo compare the analgesic effect of topical lidocaine-prilocaine (LP) cream and rectal meloxicam suppository on the post-episiotomy pain in primigravidae. Patients and methodsA randomized open-label clinical trial included primigravidae delivered vaginally with episiotomy. Eligible women were recruited and randomized to topical LP cream on the episiotomy line or rectal meloxicam suppository 15 mg. The intensity of the perineal pain was assessed using a visual analog scale (VAS) immediately, at 6, 12 h and after 5 days post-episiotomy. ResultsOne hundred ninety women were enrolled (n = 95 in each arm). No difference between both groups in the VAS scores immediately (mean ± SD: 8.54 ± 1.35 vs. 8.33 ± 1.50, p = 0.419) and 6 h after episiotomy (p = 0.859). However, women in the LP arm were more likely to report lower VAS scores at 12 h and 5 days post-episiotomy (mean ± SD: 1.20 ± 0.50 vs. 5.65 ± 1.65, p = 0.0001; 1.19 ± 0.49 vs. 2.64 ± 1.73, p < 0.001; respectively). ConclusionApplication of topical LP cream after repair of episiotomy in primigravidae seems to substantially alleviate the induced pain with subsequent less need for additional analgesia and more patients’ satisfaction.

Topical lidocaine-prilocaine cream versus lidocaine 1% subcutaneous infiltration during nexplanon insertion: a randomized controlled study

Topical lidocaine-prilocaine cream versus lidocaine 1% subcutaneous infiltration during nexplanon insertion: a randomized controlled study

Comparison of the Effects of Lidocaine-Prilocaine Cream and Lidocaine Injection on the Reduction of Perineal Pain While Doing and Repairing Episiotomy in Natural Vaginal Delivery: Randomized Clinical Trial.

BackgroundDoing and repairing episiotomy in a natural vaginal delivery is a painful phenomenon and various methods have been used to reduce its pain. Nowadays, topical ointments are being increasingly used due to low systemic absorption and ease of use.ObjectivesThe present study aimed to compare the effects of lidocaine-prilocaine cream (XYLA cream) and lidocaine injection on the reduction of pain while doing and repairing episiotomy.MethodsThis randomized clinical trial was conducted on 98 pregnant women with the gestational age of > 37 weeks. In the intervention group that contained 50 women, 5 gr XYLA cream was applied to the episiotomy area one hour prior to delivery. It was also applied to healthy wound edges to numb the area while repairing episiotomy. In the control group, lidocaine 2% injection was used at the time of delivery. The two groups were compared regarding demographic characteristics, delivery characteristics, pain intensity based on visual analogue scale (VAS), and satisfaction with the applied technique.ResultsThe results showed no significant differences between the two groups with respect to age, occupation, mother’s weight and education level, gestational age, parity, number of deliveries, and infant’s weight and head circumference (P > 0.05). Also, no significant difference was found between the two groups concerning the length of the active, second, and third phases of labor (P > 0.05). Considering postpartum complications (episiotomy wound infection), the infection was detected in three participants in the XYLA cream group and four individuals in the lidocaine group, but the difference was not statistically significant (P = 0.376). It should be noted that the application of XYLA cream did not cause eye irritation in any of the infants. The results also revealed no significant differences between the two groups regarding pain intensity and satisfaction with the applied technique after doing and repairing episiotomy (P = 0.288).ConclusionsThe results indicated that XYLA cream had no specific complications and had an effect similar to lidocaine injection while doing the episiotomy.

The effects of lidocaine–prilocaine cream on responses to intravenous catheter placement in cats sedated with dexmedetomidine and either methadone or nalbuphine

ObjectiveTo compare the reaction to cephalic intravenous (IV) catheter placement with or without lidocaine–prilocaine cream in cats sedated with dexmedetomidine and methadone or nalbuphine. Study designProspective, randomized, blind study. AnimalsA group of 24 female mixed breed cats. MethodsCats were randomly allocated to one of the two sedation protocols: dexmedetomidine (0.01 mg kg–1) and methadone (0.3 mg kg–1; DEXMET) or dexmedetomidine (0.01 mg kg–1) and nalbuphine (0.3 mg kg–1; DEXNALB). Sedation was scored 30 minutes later using a visual analog scale. Subsequently, a 2 × 3.5 cm area of the antebrachium over the cephalic vein was clipped, and half the cats within each protocol were randomly assigned for topical lidocaine–prilocaine cream (treatment), whereas no cream was applied to other cats (control). After 20 minutes, an attempt was made to place a 24 gauge catheter into the cephalic vein and the reaction of the cats to this procedure was scored using a numeric scale 0–3. Sedation and catheterization reaction scores were compared between sedation protocols and whether cats were administered lidocaine–prilocaine cream or not using the Friedman test followed by the Bonferroni procedure. A p value < 0.05 was considered significant. ResultsSedation scores were not different between sedation protocols or between treatment and control cats within each protocol. All cats administered lidocaine–prilocaine cream showed no reaction to IV catheter placement. Among the control cats, no response was observed in one cat in DEXNALB. Catheterization reaction score was lower in the treatment cats in both the sedation protocols when compared with their respective controls. Conclusions and clinical relevanceLidocaine–prilocaine cream applied for 20 minutes abolished the reaction to catheterization in cats sedated with dexmedetomidine and nalbuphine or methadone. Facilitation of IV catheter placement occurred within 20 minutes of lidocaine–prilocaine application.

Acute pain responses in dairy calves undergoing cornual nerve blocks with or without topical anesthetic

Dairy calves are routinely administered medicines, vaccines, and anesthesia via injection. Although injections are painful, little is known about methods to alleviate this pain. The aim of this study was to determine whether lidocaine-prilocaine cream, a topical anesthetic, reduced calves' pain response to a subcutaneous injection around the cornual nerve. Calves were assigned 1 of 2 treatments: lidocaine-prilocaine cream at the sites of injection (n = 10) or no cream (n = 9). Thirty minutes after treatment, calves received a subcutaneous injection of 2% buffered lidocaine hydrochloride around the left and right cornual nerves. Contrary to our hypothesis, calves that received anesthetic cream beforehand displayed more escape behaviors during the injections than control calves. Both treatments had similarly low amounts of head-related behaviors afterward. Maximum eye temperature did not differ between the calves that received anesthetic cream and control calves, although eye temperature increased over time for both treatments. Heart rate increased during the 30 s following the first injection in both treatments. There were no treatment differences for any heart rate measures over the 5-min period after the first injection (mean heart rate, root mean square of successive differences, high-frequency power, and the ratio of low-frequency power to high-frequency power). These results suggest that cornual nerve blocks with buffered lidocaine are painful and that a lidocaine-prilocaine cream was not only ineffective in reducing this pain but that it may also worsen it.

Evaluating different pain lowering medications during intrauterine device insertion: a systematic review and network meta-analysis

To synthesize the evidence on the most effective medications for the relief of intrauterine device (IUD) insertion-related pain. Systematic review and network meta-analysis of randomized controlled trials (RCTs). Not applicable. Patients undergoing IUD insertion who received different medications for pain relief versus those who received placebo. Electronic search in the following bibliographic databases: Medline via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and ScienceDirect. Visual analog scale (VAS) pain score during tenaculum placement, IUD insertion, and 5 to 20minutes after insertion, the score of easiness of insertion and the need for additional analgesics. The present review included 38 RCTs (n = 6,314 patients). The network meta-analysis showed that lidocaine-prilocaine cream (genital mucosal application) statistically significantly reduced pain at tenaculum placement compared with placebo (mean difference -2.38; 95% confidence interval, -4.07 to -0.68). In the ranking probability order, lidocaine-prilocaine cream ranked the highest in reducing the pain at tenaculum placement, followed by lidocaine (paracervical). Similarly, lidocaine-prilocaine cream ranked as the highest treatment in pain reduction during IUD insertion, followed by lidocaine (paracervical). Lidocaine-prilocaine cream is the most effective medication that can be used for IUD insertion-related pain. Other medications are not effective.

A randomized crossover trial of topical lidocaine-prilocaine cream versus lidocaine cream for analgesia during venipuncture

A randomized crossover trial of topical lidocaine-prilocaine cream versus lidocaine cream for analgesia during venipuncture

92: Effect of topical lidocaine-prilocaine cream versus rectal meloxicam suppository on relief of post-episiotomy pain

92: Effect of topical lidocaine-prilocaine cream versus rectal meloxicam suppository on relief of post-episiotomy pain

Lidocaine Prilocaine Cream versus LidocaineHCL Injection for Pain Relief during Second Degree of Perineal Tear Suturing after Vaginal Delivery: A Comparative Study

Abstract&#x0D; Objective : To compare the effectiveness of topically applied lidocaine-prilocaine cream with lidocaine-HCl injection in the reduction of pain during second degree of perineal tear suturing after vaginal delivery.&#x0D; Methods : One hundred and twenty-four of women with second degree of perineal tear after vaginal delivery were enrolled in this randomized clinical trial. Women were assigned randomly to have either application of lidocaine-prilocaine cream (n=62) or local injection of lidocaine-HCl (n=62) for anesthetic during perineal suturing. Pain measured with viasual analog scale (VAS) for the first 5 minutes during the perineal suturing. Statistical analysis was performed by comparative analytic numerical unpaired with independent t test between the two groups and significance was assessed at p&lt;0.05. Data were presented as mean ± standard deviation (SD).&#x0D; Results : There was no significantly different of pain score between lidocaine-prilocaine cream and lidocaine-HCl injection group (5.66±1.07 vs 5.56±1.5; p=0.473). &#x0D; Conclusion : Application of lidocaine-prolicaine cream as effective as injection of lidocaine for reducing pain during second degree of perineal tear suturing after vaginal delivery.&#x0D; Keywords : Lidocaine-prilocaine cream, lidocaine-HCl injection, pain, perineal suturing, vaginal delivery&#x0D; &#x0D; &#x0D; Abstrak&#x0D; Tujuan: Untuk membandingkan efektivitas antara lidokain-prilokain topikal dan lidokain-HCl injeksi dalam mengurangi nyeri selama penjahitan luka perineum tingkat dua setelah persalinan normal.&#x0D; Metode: Seratus dua puluh empat perempuan dengan robekan perineum tingkat dua postpartum pervaginam mengikuti uji coba klinis secara acak ini. Enam puluh dua perempuan (n=62) menggunakan lidokain-prilokain topikal dan 62 perempuan lainnya (n=62) menggunakan injeksi lokal lidokain-HCl untuk anestesi selama penjahitan perineum. Nyeri diukur dengan visual analog scale (VAS) untuk 5 menit pertama selama penjahitan perineum. Analisis statistik dilakukan dengan uji numerik komparatif tidak berpasangan dengan uji t independen antara kedua kelompok dengan tingkat kemaknaan p&lt;0,05. Data disajikan sebagai rerata ± standar deviasi (SD).&#x0D; Hasil: Tidak terdapat perbedaan signifikan skor nyeri antara kelompok lidokain-prilokain topikal dan kelompok injeksi lidokain-HCl (5,66 ± 1,07 vs 5,56 ± 1,5; p = 0,473).&#x0D; Kesimpulan : Efektifitas lidokain-prolikain topikal untuk mengurangi nyeri sama dengan injeksi lidokain-HCl selama penjahitan robekan perineum tingkat dua postpartum pervaginam.&#x0D; Kata kunci : Lidokain-prolikain topical, lidokain-HCl injeksi, nyeri, penjahitan perineum, persalinan normal

Nanohybrid hydrogels designed for transbuccal anesthesia.

BackgroundLocal anesthesia in dentistry is by far the most terrifying procedure for patients, causing treatment interruption. None of the commercially available topical formulations is effective in eliminating the pain and phobia associated to the needle insertion and injection.Materials and methodsIn this work we prepared a nanostructured lipid-biopolymer hydrogel for the sustained delivery of lidocaine–prilocaine (LDC-PLC) for transbuccal pre-anesthesia. The lipid was composed of optimized nanostructured lipid carriers (NLC) loaded with 5% LDC-PLC (NLC/LDC-PLC). The biopolymer counterpart was selected among alginate, xanthan (XAN), and chitosan matrices. The XAN-NLC hydrogel presented the most uniform aspect and pseudoplastic rheological profile, as required for topical use; therefore, it was selected for subsequent analyses. Accelerated stability tests under critical conditions (40°C; 75% relative humidity) were conducted for 6 months, in terms of drug content (mg/g), weight loss (%), and pH.ResultsIn vitro LDC-PLC release profile through Franz diffusion cells revealed a bimodal kinetics with a burst effect followed by the sustained release of both anesthetics, for 24 hours. Structural analyses (fourier transform infrared spectroscopy, differential scanning calorimetry and scanning electron microscopy) gave details on the molecular organization of the hybrid hydrogel, confirming the synergic interaction between the components. Safety and efficacy were evaluated through in vitro cell viability (3T3, HaCat, and VERO cells) and in vivo antinociceptive (tail-flick, in mice) tests, respectively. In comparison to a control hydrogel and the eutectic mixture of 5% LDC-PLC cream (EMLA®), the XAN-NLC/LDC-PLC hybrid hydrogel doubled and quadrupled the anesthetic effect (8 hours), respectively.ConclusionConsidering such exciting results, this multifaceted nanohybrid system is now ready to be further tested in clinical trials.