Improper use of topical anesthetic agents can result in serious adverse effects. Topical anesthetics can be absorbed and have systemic effects under certain circumstances.


Typical formulation: cream, ointment, gel


Topical anesthetic agents: lidocaine, benzocaine, prilocaine, tetracaine


Risk factors:

(1) large skin surface area exposed

(2) contact for a prolonged period of time

(3) use of an occlusive dressing

(4) application to broken skin

(5) allergy

(6) use by nonhealthcare professional

(7) formulation with a high concentration of the topical anesthetic

(8) application or generation of heat to area (including exercise)

(9) serious comorbid condition


Adverse effects may include:

(1) cardiac arrhythmias

(2) seizures

(3) coma

(4) respiratory depression or arrest

(5) death


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