Emla – local anesthesia in cream, action, indications, dosage

Emla is a combined preparation containing lidocaine and prilocaine, which is designed to act as a local anesthetic. Due to the strong active ingredients, it is available only on prescription. Lidocaine and prilocaine have an amide structure and allow you to block the generation and conduction of nerve impulses, i.e. the appearance of pain in a given place.

How does Emla work?

Emla is an ointment for topical application to the skin or mucous membranes for anesthesia and pain relief of various kinds. Two active ingredients of the preparation: lidocaine and prilocaine have an effective anesthetic effect by influencing the conduction of nerve impulses. Lidocaine blocks sodium channels in the membranes of nerve cells and the flow of sodium ions, thereby preventing the appearance and conduction of a nerve impulse. Lidocaine works effectively and very quickly on pain endings and sensory nerves. On the other hand, prilocaine works similarly, but its duration of action is prolonged.

By leaving the ointment on the skin for an hour, an anesthetic effect can be expected for another two hours.

Emla – indications for use

Emla ointment is indicated for use as a local anesthetic during procedures that require puncture and catheterization of veins, blood collection for testing, and before skin surgery. In addition, it can be used to anesthetize the mucous membranes of the genital organs for surgery or as an infiltration anesthetic.

Emla – contraindications and precautions

In turn, contraindications to the use of Emla are congenital or idiopathic methaemoglobinaemia and allergy to any component of the ointment. It is also contraindicated to use Emla ointment on damaged skin or damaged mucosa. Contraindications are also taking class III antiarrhythmic drugs, for example Amiodarn or other drugs with lidocaine or prilocaine in the composition.

Caution should be exercised when using Emla in people with glucose-6-phosphate dehydrogenesis deficiency, as there is a risk of methaemoglobinaemia. In addition, the ointment must not be allowed to come into contact with the eyes, as irritation and even anesthesia of the cornea is possible, which weakens defense reflexes. Also, precautions should be taken in people with atopic dermatitis and the ointment should not be left on their skin for more than 15–30 minutes at a time.

Emli is also not used in children under 3 months of age or between 3 and 12 months of age, when the child is taking drugs that induce the formation of methaemoglobin. When using Emli as an anesthetic in children prior to vaccination, post-vaccination control of the immune response is required, as lidocaine and prilocaine have antibacterial and antiviral effects and may therefore reduce the effectiveness of vaccination.

Emla – side effects

When using Emla, side effects such as redness, pale skin, swelling, itching or burning at the site of application may occur. With long-term use in children with atopic dermatitis, purpura or ecchymosis may appear. Very rarely, there may be enough methaemoglobinaemia when using the preparation in children.

Emla – dosage

Emla is intended for topical application on intact skin, and in adults also on mucous membranes. In adults, 2 g of ointment is administered for 1-5 hours under an occlusive dressing on the skin, 5-10 g on mucous membranes for 5-10 minutes. After the working time has elapsed, wash off the cream. In children between 3 and 12 months of age, a maximum of 2 g is administered for 1-2 hours, in children up to 6 years of age a maximum of 10 g can be administered for 1-5 hours. In children over 12 years of age, up to 20 g can be administered for 1-5 hours. After the time has elapsed, the cream must be washed off.