How do I apply lidocaine (local anesthetic) ointment 5%?

How to Apply Lidocaine Ointment 5%

Apply lidocaine 5% ointment directly to the affected area using clean hands, no more than 3 to 4 times daily, and immediately wash your hands with soap and water after application. 1

Basic Application Instructions

Standard Application Technique

• Apply the ointment directly to the affected skin area using clean hands or a clean applicator 1
• Limit application frequency to 3 to 4 times daily maximum to avoid systemic toxicity 1
• Immediately wash hands thoroughly with soap and water after applying to prevent accidental transfer to eyes, mouth, or other sensitive areas 1

Age Restrictions

• For children under 12 years of age, consult a physician before use 1
• Adults and children over 12 years may use the product as directed 1

Application for Specific Clinical Scenarios

For Localized Pain (e.g., Erythromelalgia)

• Apply lidocaine ointment to affected areas such as feet, hands, or other painful regions 2
• The ointment blocks sodium ion channels required for neuronal impulse conduction, providing local anesthesia 2
• Allow at least 4 weeks of consistent use before assessing efficacy and considering alternative treatments 2

Important caveat: Lidocaine patches may be more effective than ointment because patches deliver lidocaine gradually over hours, whereas ointment provides more immediate but potentially shorter-duration relief 2

For Procedural Anesthesia

Intact Skin Procedures

• Apply 4-5 grams of ointment to the target area 2
• Cover with an occlusive dressing to enhance penetration 2
• Wait 5-10 minutes for onset of anesthesia before the procedure 2

Open Wounds (Laceration Repair)

• Place ointment directly on the open wound 2
• Cover with an occlusive dressing or place a cotton ball soaked with the solution into the wound 2
• Allow 10-20 minutes for the wound edges to appear blanched, indicating adequate anesthesia 2

Critical safety note: Do not use on grossly contaminated wounds or in patients with known allergy to amide anesthetics 2

Safety Considerations and Contraindications

Absolute Contraindications

• Allergy to amide local anesthetics (lidocaine, prilocaine, bupivacaine, etc.) 2
• Grossly contaminated wounds (for wound applications) 2

Application Area Limitations

• Do not apply to areas larger than 300 cm² without medical supervision 3
• The face alone is approximately 200 cm², while face, neck, and chest combined exceed 400 cm² 3
• Larger application areas increase risk of systemic absorption and toxicity 3

Concurrent Use with Other Local Anesthetics

• Do not use topical lidocaine simultaneously with other local anesthetic interventions 2
• If using injectable local anesthetics, wait at least 4 hours after removing topical lidocaine before administering nerve blocks or infiltration 2
• Remove lidocaine patches/ointment before starting intravenous lidocaine infusions 2

Signs of Toxicity to Monitor

Early Warning Signs (Neurological)

• Peri-oral tingling or numbness of the tongue 2
• Tinnitus (ringing in the ears) 2
• Light-headedness 2
• Restlessness 2

Late/Severe Signs (Cardiovascular)

• Slurred speech 2
• Muscle twitching 2
• Loss of consciousness 2
• Cardiac arrhythmias 2

If any signs of toxicity occur, immediately discontinue use and seek medical attention.

Common Pitfalls to Avoid

• Never apply to mucous membranes or broken skin without specific medical guidance, as absorption is significantly increased 3
• Do not exceed the maximum daily application frequency of 3-4 times, as cumulative dosing increases toxicity risk 1
• Avoid applying to large surface areas (>300 cm²) without medical supervision 3
• Do not assume complete pain relief—topical anesthetics may provide only partial analgesia for some procedures 4
• Remember that ointment formulations may be less effective than patch formulations for sustained pain control 2