Anesthetics have been around for over 175 years! There are two local anesthetic agents used in dentistry that reportedly induce methemoglobinemia. Many invasive procedures would not be performed without the use and advances of topical/local anesthetics. In one study, researchers compared the effectiveness of topical 20% benzocaine with TAC 20 Alternate during placement of temporary anchoring devices.21 The success rate for the TAC 20 Alternate was 100%, and the authors reported significantly lower pain levels than with benzocaine, which only had a 29% success rate.21 Because TAC 20 Alternate is not regulated by the FDA, there is no information available regarding safe application, indications, contraindications, MRD or adverse reactions.3. Their efficacy is comparable when injected into deep tissue as well as mucous membranes. Available by prescription, compounded agents are meant to be used for an individual patient, and should not be used as an office-wide drug.15 Cases of misuse and serious reactions have occurred with compounded agents, including methemoglobinemia, which has prompted FDA regulatory action.12,1720, TAC 20 Alternate is a compounded topical gel composed of 20% lidocaine, 4% tetracaine and 2% phenylephrine.13 The drug concentrations used in compounded agents are important to note before using on patients. It is available in up to 20% concentrations. There are higher risks with sedation and general anesthesia, especially in older adults and people with other health complications. Sometimes, light sedation is added to local anesthetics to help relax a person. It is most often used as a mouthrinse to provide widespread topical anesthesia throughout the oral cavity as well as to suppress the gag reflex. Systemic absorption of the drugs in topical anesthetics Featured image byMR_WILKE/E+/GETTY IMAGES PLUS. 2020 Aug;20(4):241-250. doi: 10.17245/jdapm.2020.20.4.241. Medically reviewed by Drugs.com. Children and those with special needs require careful evaluation of the type and level of anesthetics they need. Topical anesthetic agents. 2022. WebAs described in this article, there are many advances in topical and local anesthesia. Excretion=Via kidney (<10% unchanged,>90% metabolites), Faster onset of action compared with other amides, An analogue to prilocaine in which benzene rings found in all other amides have been replaced with thiophene rings, Vasodilatory properties similar to lidocaine, Methemoglobinemia is a potential side effect, Contraindicated in patients with sulfa allergies because it contains methylparaben, The carbons added to mepivacaine molecules increase potency and duration of action, Greater vasodilation than lidocaine but less than procaine, Indicated for management of postoperative pain, Longer onset compared with lidocaine or mepivacaine. (2018). Get unlimited access to our CE, Adopting a multidisciplinary approach can improve, This case series presents a clinical solution to r, The February issue of Decisions in Dentistry is no, In this episode of The Art of Dental Finance and M. Describe common forms of dental topical anesthetics, and clinical considerations when using various formulations. Available at: https://www.fda.gov/Drugs/DrugSafety/ucm608265.htm. The use of compound topical anesthetics: a review. A painful stimulus can be a procedure, injections, or to blunt gag reflexes. Unfortunately, pain, or the fear of pain, keeps some of our patients from seeing us. Alternatives for Topical Anesthesia. Indicated for uses on all accessible mucous membrane except the eyes. Most people dont experience adverse reactions with local anesthesia. An official website of the United States government. Large doses of local anesthetics in themselves may result in central nervous system A painful stimulus can be a procedure, injections, or to blunt gag reflexes. Compliance with local anesthetic dosing guidelines is the first and most important strategy for preventing this adverse event. 2012 Jan;56(1):133-48, ix. When properly administered, topical anesthetics usually provide anesthesia of oral mucosa to a depth of 2-3mm. FromDecisions in Dentistry. It is poorly absorbed into cardiovascular system. Federal government websites often end in .gov or .mil. 2023 - Decisions in Dentistry All Rights Reserved. Flurori-methane is a topical local anesthetic spray that aids in myofascial pain in patients with temporomandibular dysfunction. Drugs and products containing esters are contraindicated in patients with a PABA allergy or atypical pseudocholinesterase activity.1 Considering that PABA is a metabolic by-product of the drug and a potent allergen that can lead to anaphylactic shock, products with high concentrations of an ester should be used with caution.1 Prolonged application of any dental topical anesthetic, whether it is manufactured or compounded, can cause tissue irritation and transitory taste perversion.3, Kovanaze (St. Renatus) is the first FDA-approved drug that provides pulpal anesthesia without requiring injection.20 It is a nasal spray formulated with 6 mg tetracaine HCl and 0.1 mg oxymetazoline HCl in each 0.2 ml spray.20 This agent is only meant for intranasal use and provides pulpal anesthesia from the second maxillary right premolar to the second maxillary left premolar.20 The drug is administered on the same side nostril as the maxillary teeth on which the procedure is being completed,20 and is intended for use on adults and children weighing 40 kg or more. * epi = epinephrine; levo = levonordefrin, The volume of a dental cartridge is approximated to 1.8 mL, 1:100,000 epi = 0.01 mg/mL; A 1.8 mL cartridge contains 0.018 mg epi, Maximum Recommended Dose (MRD); 1.0 kg = 2.2 lbs; 70 kg adult = 150 lbs. Topical anesthetics The role of topical anesthetic is to minimize painful stimuli or dull the effect of the procedure. Phenylephrine, a vasoconstrictor, increases the duration of the drug. The first agent is the topical local anesthetic benzocaine and the second agent is the injectable (and topical) local anesthetic prilocaine. This course fulfills MSBDE educational requirements for registered dental hygienists. PMC Lee HS. Today there are many options available for dental anesthetics. There are two local anesthetic agents used in dentistry that reportedly induce methemoglobinemia. sharing sensitive information, make sure youre on a federal The manufacturers of the medications mentioned in this article are supporters of RDH magazine. Anxiety related to dental procedures is common but can complicate treatment. Topical Anesthetic Dental Gel Prescribing Information. They can be used to numb any area of the skin as well as the front of the eyeball, the inside of the nose, ear or throat, the anus and the genital area. When properly administered, topical anesthetics provide anesthetic effect in oral mucosa to a depth of about 23 mm.1 So, while topical anesthetics may be very useful for procedures that may not require injections, they dont provide sufficient pulpal anesthesia to warrant their use as a substitute for local anesthesia when a greater depth of anesthesia is necessary.1, Topical anesthetics may employ a variety of agents, including amides (such as lidocaine and prilocaine), esters (such as benzocaine, butamben, and tetracaine) and ketones (such as dyclonine). Becker DE. The FDA Modernization Act of 1997. Our website services, content, and products are for informational purposes only. WebTopical anesthetics, applied with a swab, are routinely used to numb the area in the mouth or gums where the dental work will be done. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); This site uses Akismet to reduce spam. Last updated on Aug 22, 2022. Click to see our Topical Anesthetics. The systemic toxicity should be low. The formal continuing education programs of this program provider are accepted by the AGD for Fellowship/Mastership and membership maintenance credit. There are two local anesthetic agents used in dentistry that reportedly induce methemoglobinemia. For example, a study found children with cerebral palsy had the highest number of airway-related adverse reactions to general anesthesia. There are more risks with IV sedation. The first agent is the topical local anesthetic benzocaine and the second agent is the injectable (and topical) local anesthetic prilocaine. Children may need dose adjustments to avoid adverse reactions or overdose. Available at: https://www.fda.gov/drugs/developmentapprovalprocess/developmentresources/labeling/ucm093307.htm. The mechanism of action is that both of these anesthetics oxidize hemoglobin to methemoglobin. Keywords: In the pediatric population the clinician must be aware of the maximum dosage of lidocaine that should be considered, which is 4mg/kg without epinephrine. Topical Anesthetic Dental Gel Prescribing Information. All the local anesthetics have an aromatic ring that gives them lipid solubility. LA can be administered as gels, cream, ointment, liquid, sprays, or lotions. Note: Although the use of local anesthetics is the foundation of pain control in dentistry and has a long record of safety, dentists must be aware of the maximum, safe dosage limits for each patient. Bell K. Topical anesthetics for dental hygiene procedures. Lidocaines short duration and bupivacaines long duration are due, in part, to their distinctly different protein binding characteristics. 2017 Apr;61(2):xiii. A combination strategy for managing postoperative pain using a nonsteroidal anti-inflammatory analgesic such as ibuprofen or naproxen, prior to or immediately following surgery in combination with a long-acting anesthetic following surgery, may limit the need for opioid analgesic. Tulsi J. Patel, RDH, MHA, is an assistant professor at The University of Texas Health Science Center at Houston in the Department of Periodontics and Dental Hygiene. Dent Clin North Am. The first agent is the topical local anesthetic benzocaine and the second agent is the injectable (and topical) local anesthetic prilocaine. All rights reserved. This can be with or without consciousness. Dent Clin North Am. Accept Anesthesia means a lack or loss of sensation. The https:// ensures that you are connecting to the 2. J Philipp Dent Assoc. Amide local anesthetics are metabolized in the liver and no para -aminobenzoic acid (PABA) is formed. Reznik DS, Jeske AH, Chen JW, English J. If the safety facts are not available, clinicians should refer to the FDA website for information on approved drugs. Special precautions when taking dental anesthetics, chronic obstructive pulmonary disease (COPD), nigms.nih.gov/education/pages/factsheet_anesthesia.aspx, ada.org/en/member-center/oral-health-topics/anesthesia-and-sedation, mouthhealthy.org/en/az-topics/a/anesthesia-and-sedation-for-your-child, ada.org/~/media/ADA/Education%20and%20Careers/Files/anesthesia_use_guidelines.pdf, anesthesiology.pubs.asahq.org/article.aspx?articleid=2670190, Side Effects of General Anesthesia: What to Expect, Going Under Anesthesia May Impact Your Memory, Everything You Need to Know About Treating an Underbite, children with attention or behavior disorders, substance misuse or substance use disorder, anesthetics articaine and prilocaine at 4% concentrations may cause nerve damage, known as. Cetacaine is a combination of benzocaine, tetracaine, butyl aminobenzoate, and benzalkonium chloride. A metered spray is suggested if an aerosol preparation is selected. If youre pregnant, your dentist or surgeon will discuss risks versus benefits of anesthetics for you and your baby. 1995 Sep-Nov;47(2):35-43. U.S. Food and Drug Administration. Evaluation of general anesthesia and sedation during dental treatment in patients with special needs: A retrospective study. Oral Maxillofac Surg Clin North Am. Lidocaine is probably the most common topical and local anesthetic; it is classified as an amide. 1 Many topical anesthetics are formulated in higher concentrations This phenomena invariably occurs with excessive dose of either agent. LA takes its effect by decreasing the permeability of the ion channels to sodium therefore decreasing the rate of depolarization. Anesthetics can be short-acting when applied directly to an area or work for longer times when more involved surgery is required. Topical anesthetics may employ a variety of agents, including amides (such as lidocaine and prilocaine), esters (such as benzocaine, butamben, and tetracaine) and ketones (such as dyclonine). General anesthesia has more risks involved with its use than local anesthesia or sedation. ** Drugs that have Pregnancy Category Rating of C should be used with caution during pregnancy. 2010 Oct;54(4):757-68. doi: 10.1016/j.cden.2010.06.017. Package insert / product label Generic name: benzocaine Dosage form: gel Drug class: Topical anesthetics. Single drugs often used as topical anesthetics in dentistry in-clude 20 percent benzocaine, five percent lidocaine, and four percent tetracaine.15 Topical anesthetics are effective on surface The viscous liquid dispenses easily, flows deep into pockets, and absorbs into the mucosa. Although vasoconstrictors are rarely contraindicated, the potential stimulation of the cardiovascular system following intravascular injections should guide the dental practitioners to avoid vasoconstrictor-containing formulations in cardiovascularly compromised populations if possible. When lidocaine is used in its viscous state (0.5%, 1.0%, and 2.0%) form, the goal is to help patients with pain in mucositis secondary to chemotherapy and radiation therapy. Theyll also provide a way for you to contact them in case you have any complications or questions. WebThe most common topical anesthetics used in dentistry are those containing benzocaine or lidocaine. Kravitz ND. Note that the risk of overdose with amide topical anesthetics such as lidocaine is greater than with esters. Alternatives for Topical Anesthesia. Baddest Topical in Town is another common compounded topical anesthetic. Youll be completely unconscious, have no pain, your muscles will be relaxed, and youll have amnesia from the procedure. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). WebTopical anesthetics The application of a topical anesthetic may help minimize discomfort caused during administration of local anesthesia. If theres a history of stroke, Alzheimers disease, Parkinsons disease, thyroid disease, or mental illness, there may be an increased risk with general anesthesia. Professional familiarity with new dental topical anestheticagents is a key element of safe, effective and comfortable care. Kovanaze. Chugh A, Singh S, Khatana S, Gaur S, Patnana AK, Chugh V, Kumar P. J Maxillofac Oral Surg. Medically reviewed by Drugs.com. Lim MAWT, et al. Accessed August 1, 2022. https://www.septodontusa.com/products/dyclopro. Topical anesthetics are applied directly to your skin or mucus membranes, such as the inside of your mouth, nose, or throat. Topical anesthetics may employ a variety of agents, including amides (such as lidocaine and prilocaine), esters (such as benzocaine, butamben, and tetracaine) and ketones (such as dyclonine). WebTopical anesthetics, applied with a swab, are routinely used to numb the area in the mouth or gums where the dental work will be done. Maximum dosage should be calculated to prevent toxicity in pediatrics and adult patients. MeSH Were conduct, Last chance! When properly administered, topical anesthetics usually provide anesthesia of oral mucosa to a depth of 2-3mm. When using FDA-approved topical anesthetics, clinicians are advised to be familiar with correct application techniques, implications for use, contraindications, and risks for adverse reactions. Anesthesia and Sedation Color Coding of Local Anesthetic Cartridges Dental Anesthesiology ADA Policies on Anesthesia and Sedation ADA Resources Other Resources Last Updated: November 9, 2021 Prepared by: Department of Scientific Information, Evidence Synthesis & Translation Research, ADA Science & Research Topical and local anesthetics have played a great role in dentistry in alleviating the fears of patients, eliminating pain, and providing pain control. Accessed August 1, 2022. https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/021451s007lbl.pdf, DycloPro dyclonine hydrochloride topical solution, USP, 0.5%. Allergic reactions to benzocaine are possible, especially with prolonged or repeated application, so it should be avoided in patients who are allergic to esters or para-aminobenzoic acid (PABA).2 It is important to interview patients to learn about their previous experiences with anesthetics, especially if they have self-medicated with over-the-counter topical anesthetic agents containing benzocaine. A compounded topical anesthetic mixes pharmaceutical medications in varying ratios to create a customized drug, as indicated by a specific prescription.15 Compared to other types of dental topical anesthetics, compounded agents are typically more potent due to high drug concentrations, which means they may offer longer duration times.15 Tetracaine is a key ingredient of most compounded topical anesthetics and can be highly toxic if misused.12 A chief issue surrounding compounded topical anesthetics is they are neither FDA-regulated nor unregulated. WebA topical anesthetic is a local anesthetic that is used to numb the surface of a body part. Many invasive procedures would not be performed without the use and advances of topical/local anesthetics. Your heart rate, blood pressure, and breathing must be carefully monitored in moderate or deep sedation. Topical anesthetics only provide soft tissue anesthesia, and the depth and duration of anesthesia are less than are provided by injectable anesthetics. Common amide local anesthetics include lidocaine, mepivacaine, prilocaine, articaine, etidocaine, and bupivacaine. Disclaimer: This drug has not been found by FDA to be safe and effective, and this labeling has not been approved A metered spray is suggested if an aerosol preparation is selected. Gels and ointments are optimal for application at needle insertion sites and generally are not recommended for application on large surface areas. They can be very useful for procedures which may not require injections, such as probing, scaling in presence of inflammation, and alleviating gag reflex (radiographs, impressions). This risk increases with the size of the area of application as well as with concomitant administration of injectable versions of these same agents. Topical benzocaine and methemoglobinemia. The Effect of Granisetron on Sensory Detection and Pain Thresholds in Facial Skin of Healthy Young Males. Dental topical anesthetics are among the most common drugs used in patient care, but their risks and adverse reactions are not always well known; in addition, many practitioners are not well versed in U.S. Food and Drug Administration (FDA) regulations regarding their use. The mechanism of action is that both of these anesthetics oxidize hemoglobin to methemoglobin. Professional familiarity with new dental topical anestheticagents is a key element of safe, effective and comfortable care. Ask if you need to arrange for transportation after the procedure and any other information you need to know. These levels make it more potent than most injectable drugs, thus the need for caution. It is available in up to 20% concentrations. This course fulfills MSBDE educational requirements for registered dental hygienists. The goal for LA is to provide loss of sensation at the area of the body by depression of excitation in nerve endings and inhibition of the conduction process in peripheral nerves. The professional lidocaine topical anesthetic is formulated in a 5% ointment. DOI: What are the types of dental anesthetics? LA can be administered Sprays are most often used to reduce gag reflex during intraoral radiography or impression-taking. We'll assume you're ok with this, but you can opt-out if you wish. Oraqix is a soft-tissue anesthetic intended for subgingival use during nonsurgical periodontal debridement. (2017). Patel can be reached at [emailprotected], Role of Medication in Osseointegration of Dental Implants, Evidence for Mouthrinses asAdjunctive Therapy, Diagnosing and Treating Nasopalatine Duct Cysts, Porphyromonas gingivalis Role In the Pathogenesis of Periodontal Disease, Broadening Clinical Perspectives on Inferior Alveolar Nerve Blocks. The topical application also helps patients suffering from autoimmune blistering disease such as pemphigus and pemphigoid of the oral cavity. Oral Maxillofac Surg Clin North Am. Treatment includes medications and, Learn about the causes of an underbite, as well as its impact on quality of life, and how an underbite is commonly treated by doctors, including, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Topical anesthetics The role of topical anesthetic is to minimize painful stimuli or dull the effect of the procedure. Many invasive procedures would not be performed without the use and advances of topical/local anesthetics. The duration of LA is based on the drug selected, which is based on the length of the procedure. Easy to use and suitable for a variety of dental applications, our dental numbing gel, sprays, liquids, As the level of methemoglobin continues to increase in the blood, cyanosis develops and additional symptoms appear with the potential for progression to unconsciousness and death. DOI: Guidelines for use of sedation and general anesthesia by dentists. We break it down so youll feel more confident before your next dental appointment. Sedation has several levels and is used to relax a person who may have anxiety, help with pain, or keep them still for the procedure. If youre taking pain medications such as opioids or gabapentin, or anxiety medications like benzodiazepines, let your dentist or surgeon know so they can adjust your anesthetic accordingly. Note: Although the use of local anesthetics is the foundation of pain control in dentistry and has a long record of safety, dentists must be aware of the maximum, safe dosage limits for each patient. Fortunately, methemoglobinemia treatments using methylene blue are generally effective. The area will be numb, so you wont feel pain. While a third spray can be administered 10 minutes after the second spray if adequate anesthesia is not achieved, no more than three sprays (18 mg) should be used in adults. Systemic absorption of the drugs in topical anesthetics Topical anesthetics only provide soft tissue anesthesia, and the depth and duration of anesthesia are less than are provided by injectable anesthetics. Each has specific uses. Pain: Prevention, management, or therapy? What are the side effects of dental anesthesia? List some of the contraindications for various topical anesthetics used in dental settings. Contains 3 active ingredients (14% benzocaine, 2% butamben, and 2% tetracaine hydrochloride) to control pain and ease discomfort during dental and medical procedures. The maximum number of cartridges for an adult receiving 2% lidocaine 1:100,000 or 1:50,000 epinephrine are based on the 0.2 mg maximum for epinephrine in these formulations. You can learn more about how we ensure our content is accurate and current by reading our. U.S. Food and Drug Administration. WebCetacaine: Topical Liquid Anesthesia. In fact, the first recorded procedure with an anesthetic was done in 1846 using ether. WebCetacaine: Topical Liquid Anesthesia. Single drugs often used as topical anesthetics in dentistry in-clude 20 percent benzocaine, five percent lidocaine, and four percent tetracaine.15 Topical anesthetics are effective on surface Unmetered sprays are generally not recommended as their dosage is uncertain, they are difficult to confine to a specific site, and they may be inadvertently inhaled.2, Benzocaine is by far the most popular and most frequently used topical anesthetic agent in dentistry. Cetacaine Topical Anesthetics. Lidocaine, the first amide anesthetic, was introduced into dental practice in the 1950s and has become one of most popular dental local anesthetics in the United States. Package insert / product label Generic name: benzocaine Dosage form: gel Drug class: Topical anesthetics. By understanding these aspects of dental topical anesthetics, clinicians can help make dental procedures more comfortable while minimizing any adverse reactions. WebAs described in this article, there are many advances in topical and local anesthesia. U.S. Food and Drug Administration. Belmont Publications, Inc. presents Decisions CE. We avoid using tertiary references. The most common forms of topical anesthetics include gels and ointments, sprays, and liquids. Topical anesthetics are available in creams, ointments, aerosols, sprays, lotions, and jellies. Available at: https://www.fda.gov/downloads/drugs/guidancecomplianceregulatoryinformation/guidances/ucm070290.pdf. There are two local anesthetic agents used in dentistry that reportedly induce methemoglobinemia. 7047547 Michael Pettigrew | Dreamstime.com, How to sleep better and deeper with mouth tape, Advice for correct pediatric jaw development, What pediatric dentists want dental hygienists to know, 87461519 Antonio Guillem | Dreamstime.com, Take your patients' blood pressure: It could save their life. Click to see our Topical Anesthetics. The media portraying dentistry as being painful, or showing a dentist with needles, enlists fear and distrust of dentists. Benzocaine (ethyl aminobenzoate) is an ester local anesthetic. The role of topical anesthetic is to minimize painful stimuli or dull the effect of the procedure. St George G, et al. Before It is not known to produce systemic toxicity but can produce local allergic reactions especially after prolonged or repeated use. Local anesthetics are available over the counter and as a prescription in gel, ointment, cream, spray, patch, liquid, and injectable forms. It is a former pregnancy category B drug, which means caution should be used when administering to a pregnant patient.3 Potential adverse reactions for topical lidocaine include hypersensitivity, with the following possible symptoms: hives, swelling of lips, tongue, pharynx, larynx or anaphylaxis.7, Available in gel, spray and liquid forms, Cetacaine is a combination of three ester topical anesthetics, 2% tetracaine, 14% benzocaine and 2% butamben.11 It is not an FDA-approved drug, therefore, the MRD is unknown but caution is indicated due to its tetracaine content and rapid absorption.3 Introduced as a safer alternative to cocaine, tetracaine has a longer duration and is five to eight times more potent.12 The onset time is typically 30 seconds, and it has a duration of 30 to 60 minutes.11 According to the manufacturer, safe applications of the liquid form includes a dose of not more than 0.40 ml; however, the manufacturer does not specify weight limits for children or adults.11 Contraindications for the drug include allergies to esters or PABA. Adequate LA has been found to reduce the need for inhalation anesthetics for patients undergoing general anesthesia Local anesthetics are divided into amides and ester. She is also a clinical instructor for dental hygiene practice courses. Benzocaine is an ester derivative topical anesthetic. When applied in metered amounts to oral mucosa, topical anesthetics have limited absorption and reports of adverse reactions are rare and usually limited to localized allergic reactions. 2021 Dec;25(12):6779-6790. doi: 10.1007/s00784-021-03965-x. The administration of local anesthesia by injection is an important component of adequate pain management and hemostasis. Easy to use and suitable for a variety of dental applications, our dental numbing gel, sprays, liquids, While this certainly applies to postprocedural pain, we cannot overlook the impact of periprocedural pain on patients perceptions of overall pain as part of their dental hygiene experience. Bethesda, MD 20894, Web Policies and transmitted securely. Padminee K, Hemalatha R, Shankar P, Senthil D, Trophimus GJ. Caution is advised especially in children because of the prolonged anesthesia effects associated with lip biting and trauma. Sign up here. The medication might be given orally (tablet or liquid), inhaled, intramuscularly (IM), or intravenously (IV). Topical anesthetics may contain a variety of drugs including benzocaine, butamben, dyclonine hydrochloride, lidocaine, prilocaine, and tetracaine. Indicated for uses on all accessible mucous membrane except the eyes. Ester is metabolized in the plasma and in the liver by plasma pseudocholinesterase. The availability of a 3% formulation not containing a vasoconstrictor is a valuable addition to a dentists armamentarium. Injectable local anaesthetic agents for dental anaesthesia. Anesthesia means a lack or loss of sensation. Accessed August 1, 2022. https://www.fda.gov/Drugs/DrugSafety/ucm608265.htm, Cetacaine topical anesthetics. The first agent is the topical local anesthetic benzocaine and the second agent is the injectable (and topical) local anesthetic prilocaine. WebCetacaine: Topical Liquid Anesthesia. HHS Vulnerability Disclosure, Help Whether this initial excitatory reaction is apparent or not, a generalized CNS depression with symptoms of sedation, drowsiness, lethargy and life-threatening respiratory depression follows if blood concentrations of the local anesthetic agent continue to rise.
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