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Correspondence |
Nagoya, Japan
To the Editor:
Lidocaine tape (Penles®, Japan Lederle, Tokyo, Japan) is a self-adhesive poultice for local anesthesia containing 18 mg of lidocaine at a concentration of 60% in a 30.5 x 50.0 mm polyester film. It has been reported that lidocaine tape provides effective skin analgesia, minimizing the pain caused by percutaneous cannulation, stellate ganglion block, and propofol injection.1–3 Eutectic mixture of local analgesics has also been used to alleviate cutaneous pain in children and adults.4 However, for optimal analgesic effects, the correct amount of the drug must be applied and the skin should be properly dressed for an effective absorption.4 In this regard, lidocaine tape has advantages and is frequently used because of easier application. However, although the tape is clinically useful, elevation of the pain threshold as measured by depth of needle insertion and the optimal duration of application remain unclear.
The present study was undertaken to examine the effects of lidocaine tape on the sensitivities to pain at the sites of epidural block. Thirteen outpatients receiving a series of epidural blocks at the pain clinic of the university hospital were subjected to a double-blind study. Lidocaine or placebo tapes were applied to the block site on the back (paramedian approach) or to a symmetrical position opposite to the block site (control site) for 30, 60, 90, or 120 min. Then, to test the degree of analgesia, a 23-gauge needle was inserted vertically into the skin. The depth at which patients first felt pain was measured. Depth was 3.38 ± 2.60 mm at 30 min, 9.31 ± 6.25 mm at 60 min, 11.54 ± 5.72 mm at 90 min, and 11.69 ± 6.18 mm at 120 min after application of the lidocaine tape (Figure). Depth at which pain was elicited were significantly greater in the lidocaine tape sites than with placebo (P < 0.05). No differences were observed at control sites. Our results indicate that the application of lidocaine tape for 90 min is the shortest optimal period to minimize the pain on needle insertion in patients receiving epidural blocks and that it can provide analgesia to a mean depth of 12 mm.
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1 Jin T, Iida T, Isozaki K. Continuous pain-relieving effect of a local anesthetic tape (Japanese). J Clin Anesth 1996; 20: 519–22.
2 Inada T, Uesugi F, Kawachi S, Inada K. Lidocaine tape relieves pain due to needle insertion during stellate ganglion block. Can J Anaesth 1997; 44: 259–62.
3 Yokota S, Komatsu T, Komura Y, et al. Pretreatment with topical 60% lidocaine tape reduces pain on injection of propofol. Anesth Analg 1997; 85: 672–4.[Abstract]
4 Bjerring P, Arendt-Nielsen L. Depth and duration of skin analgesia to needle insertion after topical application of EMLA cream. Br J Anaesth 1990; 64: 173–7.
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) and the placebo site (
). Lidocaine tape increased depth compared to control. (*P < 0.05). No differences were observed at control sites.