Related Experiment Video

Updated: Oct 12, 2026

Guidelines for Elective Pediatric Fiberoptic Intubation
11:19

Guidelines for Elective Pediatric Fiberoptic Intubation

Published on: January 17, 2011

Lidocaine + prilocaine before 3 months of age: new indication. Correct use is crucial

    Prescrire International
    |September 30, 2000
    PubMed

    Insights

    Lidocaine and prilocaine cream is now approved for infants 0-3 months for skin anesthesia. While effective for circumcision pain compared to placebo, its efficacy is less than other methods for newborn procedures like heel pricks and venipuncture.

    Area of Science:

    • Pediatric Anesthesiology
    • Dermatology
    • Pharmacology

    Background:

    • Lidocaine and prilocaine combination was previously contraindicated for infants aged 0-3 months.
    • Recent clinical data supports its use in this age group for skin anesthesia.
    • Methodological quality of the clinical file for this age range is acceptable.

    Purpose of the Study:

    • To evaluate the efficacy and safety of lidocaine and prilocaine for anesthesia in neonates and infants.
    • To assess the analgesic effects in procedures like circumcision, heel blood sampling, and venipuncture.
    • To review the approved indications for lidocaine and prilocaine in young children.

    Main Methods:

    • Systematic review of clinical trials and studies on lidocaine and prilocaine.
    • Comparative analysis of efficacy against placebo, penile block, and local anesthetic injections.
    • Assessment of adverse events, including symptomatic methaemoglobinaemia.

    Main Results:

    • Lidocaine and prilocaine cream showed efficacy over placebo for circumcision pain prevention.
    • Efficacy was lower than penile block or local anesthetic injection for newborn circumcision.
    • No significant analgesic effect was observed for heel blood sampling; moderate effect for venipuncture in newborns.
    • Symptomatic methaemoglobinaemia occurred when usage conditions were not followed.

    Conclusions:

    • Lidocaine and prilocaine combination is now approved for skin anesthesia in infants 0-3 months.
    • Its effectiveness varies by procedure, being less effective than invasive methods for certain newborn interventions.
    • Adherence to recommended usage is crucial to prevent adverse events like methaemoglobinaemia.

    Related Concept Videos

    Local Anesthetics: Common Agents and Their Applications01:23

    Local Anesthetics: Common Agents and Their Applications

    Local anesthetics (LAs) are commonly used for various applications in medical and dental procedures. Some of the common agents used are cocaine, lidocaine, and bupivacaine.
    Cocaine is an ester of benzoic acid and methylecgogine. It is used to anesthetize and vasoconstrict locally. Currently, it is used primarily for topical applications. It is beneficial for surgeries on the upper respiratory tract, providing anesthesia and shrinking the mucosa. Cocaine in the form of cocaine hydrochloride is...
    Drug Dosing: Infants and Children01:29

    Drug Dosing: Infants and Children

    Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
    Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

    Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

    Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
    One of the advantages of...
    Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

    Local Anesthetics: Clinical Application as Epidural Anesthesia

    Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
    Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
    Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia01:30

    Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia

    Depending on the target organ, local anesthetics (LAs) can be administered via various routes. In surface anesthesia, LAs are applied directly to the surface of the skin or mucous membranes. It is widely used for topical skin numbing before venipuncture or minor surgical procedures. Commonly used surface local anesthetics are lidocaine or benzocaine sprays or creams. Surface anesthesia occurs within 5 minutes and lasts for about 60 minutes. One of the main disadvantages of topical anesthesia is...
    Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

    Local Anesthetics: Clinical Application as Spinal Anesthesia

    Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...