Methemoglobinemia induced by lidocaine-prilocaine cream.

The Israel Medical Association journal : IMAJ (2014-05-20)
Oded Shamriz, Inbal Cohen-Glickman, Shimon Reif, Eyal Shteyer
ABSTRACT

With growing awareness of the importance of pain control in all procedures, the use of lidocaine-prilocaine cream (EMLA) for all ages is increasing. Lidocaine-prilocaine cream has been implicated as a cause of methemoglobinemia. Diagnostic clues may be oxygen-resistant cyanosis and an oxygen "saturation gap" between arterial blood saturation and pulse oximetry. Treatment with intravenous methylene blue is often effective. Since EMLA is often mistakenly considered risk-free it is routinely applied by medical staff in the emergency room. Subsequent to the case of EMLA-induced methemoglobinemia in an 8 year old girl we wish to alert the medical community to this phenomenon, and in this work review the relevant literature.

MATERIALS
Product Number
Brand
Product Description

Sigma-Aldrich
Methylene Blue solution, for microscopy, concentrate according to Ehrlich, concentrated, aqueous solution
Sigma-Aldrich
Lidocaine, powder
Supelco
Lidocaine hydrochloride, Pharmaceutical Secondary Standard; Certified Reference Material
Supelco
Lidocaine, Pharmaceutical Secondary Standard; Certified Reference Material
Sigma-Aldrich
Lidocaine hydrochloride monohydrate, solid
Sigma-Aldrich
Methylene Blue solution, suitable for microbiology
USP
Lidocaine, United States Pharmacopeia (USP) Reference Standard
Sigma-Aldrich
Lidocaine, analytical standard
Lidocaine hydrochloride, European Pharmacopoeia (EP) Reference Standard
Lidocaine, European Pharmacopoeia (EP) Reference Standard
Sigma-Aldrich
Prilocaine hydrochloride, ≥98% (TLC)
Prilocaine hydrochloride, European Pharmacopoeia (EP) Reference Standard
Sigma-Aldrich
Prilocaine hydrochloride, meets USP testing specifications

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