Topical anesthetics are medications applied to the skin or mucous membranes to numb and minimize pain. They can be used for pain relief from minor cuts, insect bites, and minor burns. Depending on the drug, topical anesthetics can be purchased as over-the-counter or prescription medications. Keep reading to learn more about the different types of topical anesthetics, what they are most commonly used for, and some common side effects associated with their use.
Topical anesthesia is not the same as local anesthesia. Local anesthetics work in an identical way to topical anesthetics; however, local anesthetics are injected into the affected area instead of being applied directly to the skin or mucosa. Topical anesthetics are available as creams, lotions, gels, ointments, and patches.
Menthol provides a mild cooling sensation while camphor helps relieve pain. These active ingredients may be used alone or in combination with other medications, such as over-the-counter itch and burn creams.
Yes, many topical anesthetics can be used while pregnant and breastfeeding. Topical anesthetics are less absorbed into the bloodstream and thus cause fewer side effects than injected local anesthetics. Lidocaine and prilocaine are classified as Pregnancy Category B and are considered safe options for pregnancy. Preparations containing benzocaine and tetracaine are considered Pregnancy Category C and may need to be used with caution.
Topical anesthetics are available at a wide range of prices depending on the medication. On the low end, some over-the-counter preparations, such as Cepacol lozenges, LMX cream, and AleveX can be found for under $10. Most over-the-counter preparations are between $5 and $20. Some prescription topical anesthetics, such as the Synera patch, can cost up to $200.
For local numbing and pain control, doctors typically use local anesthetics approved by the U.S. Food and Drug Administration. Many of these are also available in over-the-counter strength for home use:
[ 05-23-2018 ] The U.S. Food and Drug Administration (FDA) is warning that over-the-counter (OTC) oral drug products containing benzocaine should not be used to treat infants and children younger than 2 years. We are also warning that benzocaine oral drug products should only be used in adults and children 2 years and older if they contain certain warnings on the drug label. These products carry serious risks and provide little to no benefits for treating oral pain, including sore gums in infants due to teething. Benzocaine, a local anesthetic, can cause a condition in which the amount of oxygen carried through the blood is greatly reduced. This condition, called methemoglobinemia, can be life-threatening and result in death.
We continue to monitor the safety and effectiveness of OTC benzocaine products and intend to take additional actions in the future as needed. We will notify the public about any updates. In addition to our recent actions regarding OTC benzocaine products, we are also requiring a standardized methemoglobinemia warning to be included in the prescribing information of all prescription local anesthetics.
Health care professionals should warn patients of the possibility of methemoglobinemia and advise them of the signs and symptoms when recommending or prescribing local anesthetic products. Some patients are at greater risk for complications related to methemoglobinemia. This includes those with breathing problems such as asthma, bronchitis, or emphysema; heart disease, and the elderly. Health care professionals using local anesthetics during medical procedures should take steps to minimize the risk for methemoglobinemia. These include monitoring patients for signs and symptoms suggestive of methemoglobinemia; using co-oximetry when possible; and having resuscitation equipment and medications readily available, including methylene blue.
Benzocaine is a local anesthetic contained in some OTC products for the temporary relief of pain due to minor irritation, soreness, or injury of the mouth and throat. Benzocaine products are marketed as gels, sprays, ointments, solutions, and lozenges under brand names such as Anbesol, Orabase, Orajel, Baby Orajel, Hurricaine, and Topex, as well as store brands and generics. Prescription local anesthetics include articaine, bupivacaine, chloroprocaine, lidocaine, mepivacaine, prilocaine, ropivacaine, and tetracaine.
We have been closely monitoring the risk of methemoglobinemia with the use of OTC and prescription local anesthetics and previously communicated about this risk in 2014, 2011, and 2006. We estimate that more than 400 cases of benzocaine-associated methemoglobinemia have been reported to FDA* or published in the medical literature since 1971. There are likely additional cases about which we are unaware.
As part of our continued monitoring of this safety risk, we recently evaluated 119 cases of benzocaine-associated methemoglobinemia reported to FDA and identified in the medical literature in the 8 years between February 2009 and October 2017. We have continued to receive cases even after our 2014 communication. Most of the 119 cases were serious and required treatment. Twenty-two cases occurred in patients younger than 18 years, and 11 of these were in children younger than 2 years. Four patients died among the 119 patients, including one infant. We also conducted a study comparing the relative ability of the two local anesthetics benzocaine and lidocaine to make methemoglobin. The study showed that benzocaine generated much more methemoglobin than lidocaine in a red blood cell model.2
Commercially available lidocaine creams that are sold over-the-counter generally are made in strengths between 2-5%. A compounding pharmacy can make creams with higher percentages including a 10% lidocaine cream. These higher-strength numbing creams are available only with a prescription. The higher strength numbing creams provide a more potent anesthesia that can improve the patient experience, especially for skin and cosmetic procedures performed in dermatology offices.
The strongest lidocaine cream at the highest percentage available on the market over-the-counter is lidocaine 5% by Curist. Strengths above 5% require a doctor visit and prescription. Curist Numbing Relief contains lidocaine 5%, which is the strongest OTC lidocaine cream available at the highest percentage.
Local anesthesia is an anesthetic agent given to temporarily stop the sense of pain in a particular area of the body. You remain conscious during a local anesthetic. For minor surgery, a local anesthetic can be given via injection to the site, or allowed to absorb into the skin. However, when a large area needs to be numbed, or if a local anesthetic injection will not penetrate deep enough, doctors may use other types of anesthesia.
Regional anesthesia is used to numb only the portion of the body that will undergo the surgery. Usually an injection of local anesthetic is given in the area of nerves that provide feeling to that part of the body. There are several forms of regional anesthetics:
General anesthesia is an anesthetic used to induce unconsciousness during surgery. The medicine is either inhaled through a breathing mask or tube, or given through an intravenous (IV) line. A breathing tube may be inserted into the windpipe to maintain proper breathing during surgery. Once the surgery is complete, the anesthesiologist ceases the anesthetic and you are taken to the recovery room for further monitoring.
Before surgery, the anesthesiologist will evaluate your medical condition and formulate an anesthetic plan that takes your physical condition into account. It is vital that the anesthesiologist knows as much about your medical history, lifestyle, and medicines, including over-the-counter and herbal supplements, as possible. Some particularly important information he or she needs to know includes the following:
All recent and current prescription and over-the-counter medicines. It is also important to let your surgeon and anesthesiologist know about both prescription medicines and over-the-counter medicines you are taking, or have recently taken. Certain prescription medicines, such as coumadin, a blood thinner, must be discontinued for some time before surgery. In addition, as many people take a daily aspirin to prevent heart attack, and certain dietary supplements, doctors need to be aware of these habits, as they can prolong bleeding and interfere with medicines used by anesthesiologists.
Because anesthesia and surgery affect every system in the body, the anesthesiologist will conduct a preoperative interview. Sometimes this is done in person; in other cases, the anesthesiologist will interview you over the phone. During this interview, the anesthesiologist will review your medical history, as well as discuss the information mentioned above. He or she will also inform you about what to expect during your surgery and discuss anesthetic choices with you. This is also the time to discuss which medicines should be stopped, and which can continue before surgery, as well as when to stop eating before the surgery.
When allergies or dry eyes cause stinging or burning of your eyes, some over-the-counter (no prescription required) eye drops can help. For instance, preservative-free artificial tears can be used as often as needed for relief from stinging, burning dry eyes. However, other over-the-counter drops designed to clear the red from irritated eyes can actually cause more red eye problems if used too often.
Many types of medicines are available to help control pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Medications can help you feel more comfortable, allowing you to start moving sooner, get your strength back more quickly, and recover from surgery faster.
Be sure to talk with your doctor about all your medications -- even over-the-counter drugs, supplements, and vitamins. Depending upon the pain medicine you have been prescribed, any of these may have potential to cause a harmful reaction. Your doctor will tell you which over-the-counter medicines are safe to take while using the prescription pain medication. 59ce067264