Citation

Caré W, Larabi IA, Langrand J, Médernach C, Alvarez JC, Villa A. Int. J. Legal Med. 2019; 133(3): 843-846.

Affiliation

Centre antipoison et de toxicovigilance de Paris, hôpital Fernand-Widal, Paris, France.

Copyright

(Copyright © 2019, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1007/s00414-018-1858-9

PMID

29785585

Abstract

BACKGROUND: Eutectic mixtures of lidocaine and prilocaine are used during painful dermatological procedures. Poisoning is rarely reported in adults. MATERIAL AND METHOD: We report three cases of women who experienced lidocaine and prilocaine poisoning after laser-assisted hair removal. Plasma levels of local anesthetics were assayed by a fully validated liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) method. CASE REPORTS: The rules of application of the anesthetic cream were observed apart from the maximum dose and/or maximum surface area. One patient applied a higher dose than the maximum recommended dose (140 instead of 60 g) and all patients failed to comply with the maximum recommended surface area (600 cm²). The patients presented an unusual clinical pattern as compared with other local anesthetics overdose: signs of cardiac toxicity with no ECG changes or arrhythmia, neurological toxicity without seizures or coma, and methemoglobinemia.

DISCUSSION: Health authorities should publish explicit recommendations targeting users and prescribers with particular emphasis on the maximal surface area of application.

Language: en

Keywords

Laser-assisted hair removal; Lidocaine; Mass spectrometry; Methemoglobinemia; Prilocaine