What local anesthetic (LA) cream is suitable for a 9-year-old child?

From the Guidelines

EMLA cream (lidocaine 2.5% and prilocaine 2.5%) is a suitable local anesthetic for a 9-year-old child. According to the most recent study 1, anesthetic cream containing lidocaine and prilocaine can be applied 1 hour prior to venous access to reduce pain and anxiety.

Key Points to Consider

• Apply a thick layer of EMLA to intact skin and cover with an occlusive dressing for 60 minutes before minor procedures like venipuncture or IV insertion.
• The maximum dose for a child this age is approximately 1-2 grams per 10 square centimeters of skin, not exceeding 10 grams total.
• The cream should be applied to an area no larger than 100 square centimeters (about 4x4 inches).
• Alternative options include LMX4 (4% lidocaine) which requires only 30 minutes of application time.
• These topical anesthetics work by blocking sodium channels in nerve fibers, preventing pain signal transmission.
• They're particularly useful for children who may experience anxiety about needles or painful procedures.
• Always check for allergies to amide anesthetics before application, and avoid using on broken skin, mucous membranes, or near the eyes. As supported by 1, topical anesthesia may provide pain relief during some procedures, and EMLA has been found to decrease measures of pain during venipuncture and other procedures.

From the FDA Drug Label

The following are the maximum recommended doses, application areas and application times for Lidocaine and Prilocaine Cream USP, 2.5%/2.5% based on a child's age and weight: Age and Body Weight Requirements Maximum Total Dose of Lidocaine and Prilocaine Cream USP, 2.5%/2. 5% Maximum Application Area Maximum Application Time 7 to 12 years and > 20 kg 20 g 200 cm2 4 hours

For a 9-year-old child, Lidocaine and Prilocaine Cream USP, 2.5%/2.5% is a suitable local anesthetic cream.

• The maximum total dose is 20 g.
• The maximum application area is 200 cm2.
• The maximum application time is 4 hours. 2

From the Research

Local Anesthetic Creams for Children

• The choice of local anesthetic cream for a 9-year-old child should be based on the efficacy and safety of the cream, as well as the potential risks of toxicity 3, 4.
• EMLA cream, which contains a mixture of lidocaine and prilocaine, is a commonly used topical anesthetic cream that has been shown to be effective in children 5, 6.
• However, EMLA cream can cause methemoglobinemia, a condition that can lead to seizures, cardiac dysrhythmias, and cardiovascular collapse 3, 4.
• Lidocaine cream, on the other hand, has been shown to be effective and safe in children, with a lower risk of methemoglobinemia compared to EMLA cream 5, 6.
• The American Association of Poison Control Centers has reported cases of toxicity in children due to topical anesthetic exposures, highlighting the need for careful use and dosing of these creams in pediatric patients 4.

Suitable Options

• EMLA cream (lidocaine and prilocaine) may be suitable for a 9-year-old child, but its use should be carefully monitored due to the risk of methemoglobinemia 5, 6.
• Lidocaine cream (10% or 20%) may be a safer alternative to EMLA cream, with a lower risk of methemoglobinemia and comparable efficacy 5, 6.
• It is essential to follow the recommended dosage and application time for any topical anesthetic cream used in children, and to monitor for signs of toxicity or adverse effects 3, 4, 7.