TOPICAL ANESTHETIC
Place in Therapy
Place in therapy
Local anesthetics are often seen in combinational topical therapy for the treatment of hemorrhoids, specifically for the symptomatic treatment of pain.1 However, after an extensive literature search, the evidence to support their efficacy is lacking.1 No randomized placebo controlled trials have been completed to determine the efficacy of topical anesthetics as monotherapy. The strongest evidence was derived from a randomized trial which compared topical lidocaine 1.5% to a combination of lidocaine 1.5% and nifedipine 0.3% ointment. While the combinational therapy was more effective than lidocaine 1.5% control, 50% of patients receiving lidocaine monotherapy reported absence of pain, and 33% of patients reported modest pain relief after 2 weeks.2 Therefore this trial provides weak evidence to suggest that topical anesthetics may have some efficacy for the treatment of hemorrhoid associated pain.2 Besides this trial, secondary and tertiary literature composed the bulk of literature review results. Most references suggested that topical anesthetics may be beneficial for symptomatic relief, based on expert opinion rather than primary literature evidence.3,4
In terms of safety, the systemic absorption of topical anesthetics is quite low, resulting in low rates of adverse events.1 Case reports have suggested that long-term use of local anesthetics can result in contact dermatitis and increase the risk of systemic adverse events.1,5 Overall, if local anesthetics such as pramoxine and dibucaine are used for short durations, they appear relatively safe, but evidence for efficacy is lacking.1
References
1. Caruruthers-Czyzewski, Patricia. Chapter 38: Gastrointestinal Conditions: Hemorrhoids. In: Patient Self-Care: Helping your patients make therapeutics choices 2nd edition. Ottawa, ON: Canadian Pharmacists Association (CPhA); 2010:338-338.
2. Perrotti P, Antropoli C, Molino D, et al. (2001) Conservative treatment of acute thrombosed external hemorrhoids with topical nifedipine. Dis. Colon Rectum. 44(3):405-409.
3. American Gastroenterological Association Clinical Practice Committee. American gastroenterological association technical review on the diagnosis and treatment of hemorrhoids. Gastroenterology. 2004;126:1463-1473.
4. Alonso-Coello P, Castillejo M. (2003). Office evaluation and treatment of hemorrhoids. The Journal of Family Practice. 52(5):366-374.
5. Cusano F, Luciano S. (1993). Contact dermatitis from pramoxine. Contact Dermatitis. 28:39.
.
Local anesthetics are often seen in combinational topical therapy for the treatment of hemorrhoids, specifically for the symptomatic treatment of pain.1 However, after an extensive literature search, the evidence to support their efficacy is lacking.1 No randomized placebo controlled trials have been completed to determine the efficacy of topical anesthetics as monotherapy. The strongest evidence was derived from a randomized trial which compared topical lidocaine 1.5% to a combination of lidocaine 1.5% and nifedipine 0.3% ointment. While the combinational therapy was more effective than lidocaine 1.5% control, 50% of patients receiving lidocaine monotherapy reported absence of pain, and 33% of patients reported modest pain relief after 2 weeks.2 Therefore this trial provides weak evidence to suggest that topical anesthetics may have some efficacy for the treatment of hemorrhoid associated pain.2 Besides this trial, secondary and tertiary literature composed the bulk of literature review results. Most references suggested that topical anesthetics may be beneficial for symptomatic relief, based on expert opinion rather than primary literature evidence.3,4
In terms of safety, the systemic absorption of topical anesthetics is quite low, resulting in low rates of adverse events.1 Case reports have suggested that long-term use of local anesthetics can result in contact dermatitis and increase the risk of systemic adverse events.1,5 Overall, if local anesthetics such as pramoxine and dibucaine are used for short durations, they appear relatively safe, but evidence for efficacy is lacking.1
References
1. Caruruthers-Czyzewski, Patricia. Chapter 38: Gastrointestinal Conditions: Hemorrhoids. In: Patient Self-Care: Helping your patients make therapeutics choices 2nd edition. Ottawa, ON: Canadian Pharmacists Association (CPhA); 2010:338-338.
2. Perrotti P, Antropoli C, Molino D, et al. (2001) Conservative treatment of acute thrombosed external hemorrhoids with topical nifedipine. Dis. Colon Rectum. 44(3):405-409.
3. American Gastroenterological Association Clinical Practice Committee. American gastroenterological association technical review on the diagnosis and treatment of hemorrhoids. Gastroenterology. 2004;126:1463-1473.
4. Alonso-Coello P, Castillejo M. (2003). Office evaluation and treatment of hemorrhoids. The Journal of Family Practice. 52(5):366-374.
5. Cusano F, Luciano S. (1993). Contact dermatitis from pramoxine. Contact Dermatitis. 28:39.
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