Topical and Local Anesthetics

Local anesthesia is an important part of pediatric procedural sedation. Not only does it allow for pain reduction during intravenous catheter placement, but it can also reduce the total amount of sedation that is required during painful procedures and minimize the need for postoperative analgesia. This chapter outlines the historical aspects of topical local anesthetic use in children. The benefits and risks of topical and subcutaneous local anesthetics during procedural sedation are reviewed. While the topical use of local anesthetics is generally safe, careful titration of dosage based on the patient’s age and weight and the drug’s side-effect profile is important to prevent toxicity. Current recommendations for the treatment of local anesthetic systemic toxicity are provided.