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Lidocaine iontophoresis for topical anesthesia before dermatologic procedures in children: a randomized controlled
William T Zempsky1, Thomas M Parkinson
1Department of Pediatrics, University of Connecticut School of Medicine, Hartford, CT, USA. wzempsk@ccmckids.org
Insights
Lidocaine iontophoresis effectively reduces pain and needle phobia in children undergoing dermatologic procedures. This safe topical anesthesia method significantly decreased the need for supplemental anesthesia and reported pain levels.
Area of Science:
- Dermatology
- Anesthesiology
- Pediatrics
Background:
- Pediatric patients often experience pain and fear during local anesthesia injections for dermatologic procedures.
- Effective pain management is crucial for improving patient experience and compliance.
Purpose of the Study:
- To evaluate the efficacy and safety of lidocaine iontophoresis as a topical anesthetic in children undergoing dermatologic procedures.
- To compare lidocaine iontophoresis with placebo for pain reduction and need for supplemental anesthesia.
Main Methods:
- Prospective, double-blind, placebo-controlled study.
- Inclusion of 60 pediatric patients undergoing various dermatologic procedures.
- Application of 2% lidocaine with epinephrine via iontophoresis versus placebo.
Main Results:
- Significantly fewer patients in the lidocaine group required supplemental anesthesia (29/31 vs. 2/29).
- Lidocaine iontophoresis resulted in significantly lower pain scores reported by patients, investigators, and parents.
- Transient skin blanching or erythema was observed in most patients but resolved within an hour with no other adverse events.
Conclusions:
- Lidocaine iontophoresis is a safe and effective method for providing topical anesthesia in pediatric patients.
- This technique significantly reduces procedural pain and the need for additional anesthesia, improving the pediatric dermatologic experience.
Abstract:
Local anesthesia by injection in pediatric patients undergoing dermatologic procedures is not well received because of the pain of injection and the fear of needles. Lidocaine iontophoresis is a method of topical anesthesia where lidocaine is driven into the skin under the influence of electric current. We performed a prospective double-blind, placebo-controlled evaluation of iontophoresis of 2% lidocaine with 1:100,000 epinephrine. Sixty children requiring dermatologic procedures were enrolled (50 shave biopsy, 7 curettage, 2 injection, 1 punch biopsy). Twenty-nine of 31 patients in the lidocaine group versus 2 of 29 placebo patients required no supplemental anesthesia (p < 0.001). The pain reported by the patients on the Oucher pain scale subsequent to the procedure was significantly lower in the lidocaine group (p < 0.001). Investigators and parents also rated pain lower in the lidocaine group (p < 0.001). Blanching and/or erythema occurred in 58 of 60 patients, but resolved within 1 hour in all patients. There were no other adverse events. Lidocaine iontophoresis is a safe and effective method of topical anesthesia prior to dermatologic procedures in children.