Topical anesthetics

What types of topical anesthetics are there?

Most topical anesthetics have active ingredients from one of two types of chemical compounds, esters and amides. Some examples of esters include procaine and tetracaine, and some amides include lidocaine and prilocaine. All of these have local anesthetic effects.

Topical anesthetics usually come as creams or gels. There are also topical anesthetic sprays, often containing lidocaine. This is usually sprayed straight onto the throat before a dental procedure. It’s not usually used on the skin, because it isn’t absorbed as well as creams and gels.

Ointments, lotions, eye or ear drops, solutions, and patches containing topical anesthetics are also available.

Which topical anesthetic should I use?

The type of topical anesthetic you use will depend on what you’re using it for. That’s why it’s good to chat to a doctor first before you use them. There’s some evidence to suggest tetracaine gel works better than a cream containing lidocaine and prilocaine for procedures that pierce the skin using needles, like blood tests.¹

For laser and microneedling, lidocaine 4% cream has been shown to outperform both tetracaine gel and a cream containing lidocaine and prilocaine.²

Remember that lots of topical anesthetics have different active ingredients, so one might suit you better than another, especially if you’re sensitive to certain ingredients. It also helps to think about where and how you’ll be using it, for instance, if you’re covering a larger area, creams are often easier to apply than gels.

How is topical anesthesia different from other types of anesthesia?

Topical anesthetics are a type of local anesthetic. Local anesthesia means it affects only a specific area of the body and doesn’t lead to loss of consciousness. Topical anesthesia is unique because it has the same properties as local anesthesia, but it’s absorbed through the surface of the skin.

There are a few other types of local anesthetic, like epidurals, where the anesthesia is injected into your spinal cord to numb specific nerves. There’s also general anesthesia, which causes unconsciousness, pain relief and memory loss and stops you from moving. This is usually used for more serious surgeries, because it comes with risks.

How to use topical anesthetics

How to use topical anesthetics on the type of medication you’re using and what you’re using it for. For example, gels and creams are usually applied 30-60 minutes before the procedure to allow the skin to desensitise. You shouldn’t apply it on cut or broken skin, or somewhere you have a rash.

If you’re using a lidocaine patch, stick it onto the painful area on clean, dry, unbroken skin and leave it on for the amount of time your doctor or the medication guide says, usually up to about 12 hours.

When should I get help with topical anesthesia?

If you’re having a serious procedure, you should talk to the person performing the procedure about using a topical anesthetic. A doctor should also apply topical anesthesia for you if you’re using it on your genitals.

If you are having pain of an unknown cause, don’t use topical anesthetics to treat it. Talk to a doctor about your pain so they can figure out what’s creating it and help you find the right treatment. It’s not a good idea to use topical anesthetics too often, and you don’t want your symptoms to get worse.

Can I use topical anesthetics for vaccines?

In many cases, topical anesthetics are a great option for reducing any discomfort that comes with getting a vaccine. They’re effective for numbing the skin before a shot with a needle, so if you need a vaccine, they can make it a painless process.

Talk to a healthcare professional before mixing a topical anesthetic with a live vaccine, like the MMR and tuberculosis vaccines. There are concerns it can make live vaccines less effective, so you should follow up later to make sure it works. Evidence suggests there’s no real risk of this, but it’s safest to check with a physician first.³