psd-502 and Port-Wine-Stain

EMLA cream was developed to reduce pain during pulsed-dye laser (PDL) treatment; however, no standard assessment for the therapeutic outcomes of PDL with EMLA creams thus far available. This comparative, prospective clinical trial evaluates laser efficacy and pain reduction during PDL treatment with EMLA cream for local topical anesthesia. Nineteen patients with untreated port-wine stain (PWS) were treated using PDL and examined in this study. Treatment specifications included Vbeam® PDL (Candela Corp.), 595-nm wavelength, 9 J/cm

Topics: Female; Humans; Lasers, Dye; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Pain Measurement; Port-Wine Stain; Prilocaine; Prospective Studies; Treatment Outcome

We have used EMLA, 4% amethocaine gel and placebo for facial portwine stains, for a period of 1 h, in a double-blind study. After removal of the preparations from the skin surface, each area was treated with six pulses of the laser, each 5 mm in diameter. Any pain noted immediately after treatment was recorded using both visual analogue (VAS) and verbal rating (VRS) scores. Twenty nine patients completed the study and statistical analysis of the results indicated that both EMLA and 4% amethocaine gel were superior to placebo (P < 0.001). However, when EMLA and 4% amethocaine gel were compared, the amethocaine preparation was significantly better (P < 0.05, VAS; P < 0.005 VRS) than EMLA in reducing pain caused by the laser treatment.

Topics: Adolescent; Adult; Anesthesia, Local; Anesthetics, Local; Double-Blind Method; Drug Combinations; Humans; Laser Therapy; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Pain Measurement; Port-Wine Stain; Prilocaine; Tetracaine

Topical anesthetics are commonly used in many health care settings and for many clinical conditions. However, there are a number of potential adverse effects associated with their use. Their widespread administration can convey a false sense of security and failure to appreciate possible complications. We present the case of an infant with extensive vascular malformations treated with EMLA cream who developed seizures and methemoglobinemia from lidocaine and prilocaine toxicity. We describe the pathophysiology of these morbidities, the use of pulse oximetry in this setting, and the clinical presentation and treatment of methemoglobinemia.

Topics: Administration, Topical; Anesthetics, Local; Diagnosis, Differential; Female; Humans; Infant; Lidocaine; Lidocaine, Prilocaine Drug Combination; Methemoglobinemia; Port-Wine Stain; Prilocaine; Seizures