Volume 2, Issue 4 , Pages 229-232, December 2008
Cardiovascular Complications Resulting from Topical Lidocaine Application
Article Outline
SUMMARY
Topical lidocaine is one of the most commonly used anesthetics in the emergency department (ED). The advantages of topical anesthesia include ease of application, minimal discomfort on administration, and rapid onset of anesthesia. Systemic toxic effects after topical lidocaine application are rare. We present a case of a man aged 48 years with no history of heart disease and no evidence of bradycardia in previous electrocardiograms. The patient had sprayed lidocaine solution on the glans of his penis before sex during the 2 weeks prior to admission. Cardiovascular adverse events occurred, including chest tightness and bradycardia. After 2 hours conservative treatment at our ED, his symptoms were alleviated. He was discharged from the ED without any medication. The case suggests that detailed patient histories are necessary for accurate diagnosis and that rapid diagnosis and implementation of treatment is necessary for successful patient outcomes in cases of cardiovascular complications resulting from topical lidocaine application.
Key Words: adverse effects , bradycardia , lidocaine , topical administration
No full text is available. To read the body of this article, please view the PDF online.
References
- . Topical analgesic agents . Clin Geriatr Med . 2008;24:299–312
- . Advances in the management of neuropathic pain . Phys Med Rehabil Clin N Am . 2001;12:447–459
- . Effects of single and repeated applications of a eutectic mixture of local anaesthetics (EMLA) cream on spontaneous and evoked pain in post-herpetic neuralgia . Pain . 1999;81:203–209
- . Use of EMLA cream in the treatment of post-herpetic neuralgia . J Clin Anesth . 1996;8:54–57
- . EMLA cream for the treatment of pain caused by post-herpetic neuralgia: a doubleblind, placebo-controlled study [abstract] . In: Proceedings of the Annual Meeting of the American Pain Society . Glenview, IL: American Pain Society; 1996;p. A111
- . Lidocaine patch: double-blind controlled study of a new treatment method for post-herpetic neuralgia . Pain . 1996;65:39–44
- . Topical lidocaine patch relieves postherpetic neuralgia more effectively than a vehicle topical patch: results of an enriched enrollment study . Pain . 1999;80:533–538
- . An open-label study of the lidocaine patch 5% in painful idiopathic sensory polyneuropathy . Pain Med . 2005;6:379–384
- . Lidocaine patch 5% and its positive impact on pain qualities in osteoarthritis: results of a pilot 2-week, openlabel study using the Neuropathic Pain Scale . Curr Med Res Opin . 2004;20(Suppl):S13–S19
- . Ropivacaine overdose and systemic toxicity . Anaesth Intensive Care . 2000;28:705–707
- . Lidocaine and prilocaine toxicity in a patient receiving treatment for mollusca contagiosa . J Am Acad Dermatol . 2001;44(2 Suppl):399–400
- . Lidocaine toxicity following subcutaneous administration . Ann Emerg Med . 1984;13:465–467
- . Negligible removal of lidocaine during arteriovenous hemofiltration . Ther Drug Monit . 1990;12:154–156
- Lidocaine toxicity after subcutaneous infiltration in children undergoing cardiac catheterization . Am J Cardiol . 1991;67:647–648
- . Pharmacology of local anesthetics . Ophthalmol Clin North Am . 2006;19:155–161
- . Cardiac arrest after intraurethral administration of lidocaine . J Formos Med Assoc . 2005;104:605–606
- . EMLA toxicity after application for allergy skin testing . Pediatrics . 2004;113:410–411
- . Death following accidental lidocaine overdose in a child . N Engl J Med . 1986;314:182–183
- . Death from ARDS and cardiovascular collapse following lidocaine administration . Chest . 1983;83:585
- . Lidocaine toxicity from topical mucosal application. With a review of the clinical pharmacology of lidocaine . Clin Pediatr (Phila) . 1983;22:190–192
- . Lidocaine intoxication at very small doses in terminally ill cancer patients . J Pain Symptom Manage . 2005;30:6–7
- . Transitory ataxia related to topically administered lidocaine . Ann Pharmacother . 2004;38:828–830
- . Toxicity—seizures in an infant caused by (or related to) oral viscous lidocaine use . J Emerg Med . 1992;10:587–590
- . Intrathecal injection: unusual complication of trigger-point injection therapy . Ann Emerg Med . 1998;32:506–508
- . Maximum recommended doses of local anesthetics: a multifactorial concept . Reg Anesth Pain Med . 2004;29:564–575 discussion 524.
- . Lignocaine toxicity: a complication of local anaesthesia administered in the community . Emerg Med J . 2004;21:249–250
- . Temporary bilateral blindness after acute lidocaine toxicity . Anesth Analg . 2002;95:224–226
- . Complications of regional anaesthesia: incidence and prevention . Drug Saf . 2001;24:413–442
- . The effect of erythromycin and fluvoxamine on the pharmacokinetics of intravenous lidocaine . Anesth Analg . 2005;100:1352–1356
- . A fatal case of poisoning by lidocaine overdosage—analysis of lidocaine in formalin-fixed tissues: a case report . Med Sci Law . 2004;44:266–271
- . Lidocaine toxicity in a student undergoing upper gastrointestinal endoscopy . Gut . 2000;46:435
- . Severe lidocaine intoxication by cutaneous absorption . J Am Acad Dermatol . 1990;23:1026–1028
- . Lidocaine toxicity . Anesth Prog . 1998;45:38–41
- . [How should a toxic accident be treated?] . Ann Fr Anesth Reanim . 1988;7:227–232 [In French]
PII: S1873-9598(09)70012-2
doi:10.1016/S1873-9598(09)70012-2
© 2008 Elsevier B.V. All rights reserved.
Volume 2, Issue 4 , Pages 229-232, December 2008
