After hearing about 2 girls dying from numbing cream overdose, how really safe is it? How much should you apply and how big of an area to cover (the size of underarms, bikini area, ok?) before you risk complications? Did anyone have any bad experiences? Can you only get it with a doctor’s prescription? Any input would be appreciated!
EMLA : You need a physician’s prescription in the United States
You can order online from Canada without a prescription
L.M.X.: You do not need a prescription.You can order it online.
Just do a search on google.
The deaths you are referring to relate to a higher dosage over a large area, wrapped in plastic wrap for an hour or more. Shiri Berg (North Carolina) lost her life when she used a compounded cream, dosage 10% lidocaine, on both legs prior to laser hair reduction. She convulsed and went into a coma as she was driving to her appointmnet.
The above medications are 5% concentrations, but you should consult with your physician before using. Using these creams for your upper lip, for example is not dangerous. It’s a small area. There is a good discussion here on hairtell with more detail. Use the search feature ‘lidocaine’ or ‘anesthetics’.
Yes, these cases were simple missuse. Thanks to the large amounts used, covering such a large area, the mucosal tissues involved, and on top of all that, there was occuslive dressings (plastic wrap) to keep the body from expelling it, as it just got reabsorbed and the long period of time the stuff was in this condition — the net effect was as if they were injected with the stuff.
This is one of the reasons the laws that prohibit practitioners from applying these potions is detrimental to the consumer. It is legislating that the person least likely to do it right, is the person who is lawfully obligated to do the job.
The biggest problem in those cases was the very high concentration of lidocaine since the cream was purchased at a compounding pharmacy. If you get the properly compounded cream with under 5% lidocaine, you will be just fine, especially on such small areas. I wouldn’t even think you will need it on underarms. It takes only a couple minutes to do each one. I always advise to consider the procedure without the cream first to see if you can handle it just fine. Many people can. It’s also helpful so you know how it feels and can detect better if you’re getting burned. Avoid caffeine before treatments and you should use ice afterwards. I never found the need for the cream on any areas I had done.
At 140 lbs I’ve used at most 30 grams of EMLA (lidocaine 2.5% + prilocaine 2.5%) with an airtight dressing for 2 hours. The only side effects were a slight numbing of the tongue and skin redness, both which subsided around 4 hours after it was removed. Some might be more susceptible to side effects, but after using this treatment over a dozen times, I’m convinced EMLA is safe when used as directed. 
2.5% is fine. The problems were caused by lethal compounding of 10% lidocaine etc.
The Shiri Berg case had many components causing her overdose. She was given a compound of 10% lidocaine AND 10% tetracaine. She was not given instructions by the nurse, MD, or the receptionist on how to use the gel. She applied the gel and wrapped herself in plastic wrap from bikini to ankles. She wore sweatpants over that. It was in December, and the heater in her car was blowing on her legs. She was a petite young lady and that amount of occluded anesthetic plus the other heat speeding up the absorption, was just too much for her tiny body to handle.
I wouldn’t add the expense of a topical until I tried ice packs.
I use it for every treatment, but only in the bikini area. I haven’t had any problems.
I find that a pain pill about 30 minutes before my appt also helps. And aloe right after!
Also, wear loose cotten clothing - driving home in wool pants with your woohoo on fire isn’t a nice combination =)
Thanks for your input! I decided to get LMX 4% to numb my underarms, since the doctor did not recommend using anything higher than that and I also had to buy it. Yesterday was my first laser treatment. I shaved the day before because my skin gets irritated after shaving and the doctor said the skin should be completely healed before laser. I numbed the skin for approx. 45 mins the day of treatment, washed it off and went to my appointment. They used an alex laser on me with 25J. I could feel a little pain in certain areas, but overall it was painless. I forgot to take some tylenol before, i wonder if it would’ve helped somewhat? I was a little anxious because of the numbing cream but I’m so glad i used it and I didn’t have any bad side effects.
Do you know what alex machine was used? Was it Apogee? Do you know spot size and pulse used? Settings also make a difference in pain. Lower settings don’t hurt as much (and also not as effective). Hard to tell without the 2 other numbers though. How did you find your clinic? How many did you check out beforehand?
You should leave the cream on and let them wipe it off at the clinic for maximum effect. Did they instruct you otherwise?
the laser is called Polylase and the spot size was 12 and the pulse was 14 i think. The doctor said she will increase the power next time. I called alot of places in the Seattle area and asked them many questions (what are your prices, what laser do you have, who does the procedure, is there are a doctor on site, etc.) I got turned off by many sales person type people that sounded really desperate in medi spas. Some wouldn’t give me prices unless i went to their consultation. I ended up going to 4 consultations only in doctor’s offices. I picked a place based on location, price, laser, and the only place where a doctor does the procedure herself.
The doctor said that the numbing cream should start working in 30 mins but will be most effective in 1 hour. She said I could keep the cream on up to an hour without putting plastic wrap over it. I was really anxious and didn’t want to keep the numbing cream on for too long and because i felt really numb in the area i washed it off sooner. Also i was against covering with plastic wrap because the skin can’t breathe.
Using Emla or any product like it larger than a 4x4 area can be very unsafe.Those products are good for upper lip or chin. Occlusions SHOULD b e avoided
I had a client come with L.M.X. applied to the abdominal area (large area), wrapped in plastic for a two hour drive to my office. She was fine, but she knew that I didn’t approve of this. She did consult with her physician before doing this though. I programmed emergency numbers into my cell phone just in case.
This shows how EMLA is applied. This is on a small child.
http://www.emla.com.au/514666/
INSTRUCTIONS FOR APPLICATION:
To measure 1 gram of EMLA, the Cream should be gently squeezed out of the tube as a narrow strip that is 1.5 inches (3.8 cm) long and 0.2 inches (5 mm) wide. The strip of EMLA cream should be contained within lines that are 1.5" long - 1/4" wide.
1.5 X 0.2 inches
Use the number of strips that equals your dose, like the examples in the table below.
Dosing Information
1 gram = 1 strip
2 gram = 2 strips
2.5 grams = 2.5 strips
For adult and pediatric patients, apply ONLY as prescribed by your physician.
EMLA® Cream must be applied to intact skin at least 1 hour before the start of a routine procedure and for 2 hours before the start of a painful procedure. A protective covering of the Cream is not necessary for absorption but may be helpful to keep the cream in place.
If using a protective covering, your doctor will remove it, wipe off the EMLA® Cream, and clean the entire area with an antiseptic solution before the procedure. The duration of effective skin anesthesia will be at least 1 hour after removal of the protective covering.
Hi:
Actually I have used up to 15 gms of Emla at one time over a reasonably large area (the chest). Plastic wrapping is recommended. They also recommend you apply it fairly thick in order for it to work.
I think the problems in the field have been from a much stronger, specially compounded mixtures applied over a large area. In one case the laser center mixed a very strong compound and sold it to a client. She then covered her entire legs and then covered them with plastic wrap if I remember the article correctly.
Alicia
Yes, that’s where the problem with these deaths arose. Dosage was a problem. I have never heard of any complications or deaths with concentrations in the 4% - %5% range, but the deaths reported from lack of oversight and instruction, make us all understandably jittery and thus, we instinctively back away from reasonable usage in healthy clients. I leave all that up to the client.
This is why I purchased the Apilus Platinum. The sensation factor is much better and clients don’t need to purchase expensive topicals. So that leaves “pain” off the problem list associated with electrolysis.
Hi Dee:
I am trying to convince my electrologist to look
into an Apilus Platinum rather than her Sequentium 328.
On the plus side she knows that machine very well and what settings work best on me.
I can see why you would be jittery about the unfortunate
deaths which have occured. The stronger compounded numbing creams should only be prescribed by a doctor.
I don’t think that was the case in the deaths which occured.
In Canada we can buy Emla by talking to the pharmacist, so it is somewhat restricted. Also it is ultra expensive so covering a large area would be prohibitively expensive and that would probably dissuade someone from doing too large an area.
Alicia
It’s great to see you did your research. This looks like a relatively new machine that has both alexandrite and Yag options. Alexandrite spot size varies 10, 12 and 16mm. Pulse from 0.5ms to 100ms. And highest joules at 16mm are 25J. So the potential is very good.
Not sure what 12 and 14 are for your settings for sure, but I’m thinking maybe 12mm spot size and 14J settings, which are relatively low. You should try to get treated a 16mm spot size and as high joules and as low of pulse as your skin can handle safely.
Being a doctor or having a doctor on site is not of ultimate importance. Neither is being treated by a doctor, unless the doctor is an expert in hair removal specifically and does it all day everyday. Experience is most important and those with many years of it usually know what they’re doing best, not those with degrees in something entirely different. LHR is primarily learned through experience.
No, you misunderstood. My settings were 25 joules, spot size=12, pulse=14. I totally disagree with you that having a doctor on site is not important. I think there is a reason why many states have laws for the use of lasers and some even say only doctors can perform LHR. I don’t know what the law is in your state for using lasers, but in my state the rules are only a doctor can medically evaluate a person, decide what laser settings to use, etc before a person can get LHR and only then a nurse or PA has to be supervised by a doctor. I also think that experience is important, but not as important as someone’s education and knowledge about laser physics and techniques.