Eutectic Mixture of Local Anesthesia - Indication and Side Effects.

Introduction

A eutectic mixture is the combination of any two components in specific amounts that changes the phase of the product formed at a particular temperature. The eutectic variety in anesthesia is also in use nowadays, which is patient-friendly. It is comfortable to use by any patient and benefits the doctor as it provides cooperation to proceed with the surgery.

What Is the Eutectic Mixture of Local Anesthesia?

A eutectic mixture of local anesthesia (EMLA) is an equal quantity mixture of Lidocaine and Prilocaine in a 1:1 ratio formed as a cream or lotion to anesthetize the skin. When mixed in equal quantities by weight, they form a eutectic mixture with a lower melting point than the individual solid forms. A thick layer is applied to the skin to anesthetize to a depth of 5 mm so that the eutectic mixture can remove the superficial lesions, a needle can penetrate the skin, and minor surgeries can be performed. With the help of eutectic mixture anesthesia, the patient will not encounter needle-piercing pain.

What Are the Different Forms Present in EMLA?

Lidocaine and Prilocaine are solid bases individually. On forming a mixture of the two, their melting point lowers. The melting point of the eutectic mixture form is 18 degrees. They form an oil-in-water emulsion. They are in many forms cream, patches, gels, or lotion.

What Is the Composition of EMLA?

A eutectic mixture combines two or more drugs, as mixing anesthetics provides better results.

The formula for EMLA 5 percent is:

• Lidocaine (2.5 grams).

• Prilocaine (2.5 grams).

• Purified water (100 grams).

What Are Indications for Eutectic Local Anesthesia?

The eutectic mixture is used in different procedures with the concept of pain relief. Some indications of the eutectic mixture of local anesthesia are:

• Dermal anesthesia.

• During the insertion of the catheter.

• Blood sampling.

• Leg ulcers.

• Tattooing skin.

• Minor surgical procedures.

• Laser operations.

• Biopsies.

• Dental procedures.

• Patients on dialysis.

How Are Children Responding to EMLA?

The eutectic mixture (EMLA) has been proven to be very useful for children as it inhibits pain during any procedure. The use of needles has harmed the children and allowed them not to cooperate in proceeding with any treatments. Here, the EMLA has made the perfect choice for the anesthetic to go for the treatments, preventing the pain, comforting the patient, and allowing him to cooperate during the procedures. The doctor has difficulty performing earlier operations, but EMLA has made it easier to perform on children. There are procedures in which EMLA is required. The effective use of the EMLA before these procedures has conquered the children's will to proceed with the procedures. The use of EMLA is between 0.5 to 1 gram. The application of EMLA should be half to one hour before the procedure.

What Are the Procedures in Children That Require EMLA?

The procedures are:

• Venipuncture - It is the collection of blood from a vein.

• Cannulation - It is a technique in which a cannula is placed.

• Lumbar Puncture - It is a puncture done to diagnose specific tests.

• Vaccinations - Vaccinations are given to infants who are under one year of age.

• Curettages - It is a procedure to remove tissues.

• Laser treatments of Port Wine Stains - Port wine stains are the abnormal formation of tiny blood vessels.

How Is Dentistry Using EMLA?

Dental pain is very painful. Dentistry has invited EMLA. The EMLA has brightened the chances of inhibiting the pain. Desensitization of the oral sites by using EMLA has improved the quality of the treatment. Originally it was not formed for oral mucosa, but with increasing age, the doctor made its effective use in dentistry and on children. The oral mucosa is thinner than others, so they have faster absorption rates. Nearly five to ten minutes before the treatment can produce desirable results. Dental procedures in which EMLA is used are:

• Minor gingival surgery.

• Pocket removals.

• Scalings.

• Dental injection.

• Restorative procedures.

• Periodontal surgeries.

• Biopsies.

• Extraction.

Is EMLA Used in the Dermatologic Field?

Dermatologic is a field dealing with the skin and its layers. People are worried about their skin to go for many skin-related procedures. The EMLA has benefited this industry by affecting only the area required in a short period and exhibiting neither pain nor discomfort. As a result, they are becoming the most effective and widespread use of anesthetic agents in the dermatologic field. Some procedures include conservative excision, scar revision, skin biopsy, topical chemotherapy, and wide local excision. They apply nearly half to one hour before the treatment and perform satisfactory results.

What Are Contra-Indicatications to EMLA?

Some patients are not suitable for the EMLA. Therefore, they are contraindicated for EMLA anesthesia. These patients include:

• Patients with a history of sensitivity to amide-type local anesthetics cannot use it. Lidocaine, Prilocaine, and Bupivacaine all are amides.

• Prilocaine metabolites can cause methemoglobinemia (a blood disorder carrying methemoglobin instead of hemoglobin). Patients having congenital or acquired methemoglobinemia are not ideal for performing EMLA.

• Children who have an excessive application of EMLA cream should avoid using it.

• Infants who are under the age of twelve months can not apply for EMLA.

• Patients using class three antiarrhythmic drugs (a medicine used to treat heart rhythm) are also contraindicated.

• Patients are prohibited from applying it on the eye or ear.

What Are the Side Effects of EMLA?

Side effects of EMLA are:

Localized Reactions:

• Erythema (redness of skin).

• Hyperpigmentation.

• Blisters.

• Paleness.

• Redness.

• Itchiness.

• Burning sensation.

Allergic Reactions:

• Urticaria (skin rash occurs on reaction to food, medicine, or irritant).

• Angioedema (painless swelling under the skin due to allergy reaction).

• Bronchospasm (muscles of the bronchi gets tightened).

• Shock.

Systemic Reaction -

• CNS reactions (lightheadedness, nervousness, euphoria, confusion, vomiting, twitching, tremors).

• Respiratory depression and arrest.

• Bradycardia (low heart rate).

• Hypotension.

Conclusion

The eutectic mixture of local anesthesia is trendy. It is the combination of two drugs, Lidocaine and Prilocaine, in a ratio of 1:1. They are used in many forms of gels, patches, lotions, etc. It provides patient cooperation and support for surgical procedures. These anesthesia forms perform most pediatric patient surgeries. EMLA is used in various fields to express its analgesic property. Some of them are dermatological procedures and dental procedures. It is contraindicated in neonates, with class three antiarrhythmic drug usage patients. Even the eye and ear are not the ideal places to apply EMLA. Appropriate usage of EMLA should be done to prevent side effects.