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International Journal of Legal Medicine

, Volume 133, Issue 3, pp 843–846 | Cite as

Poisoning associated with inappropriate use of a eutectic mixture of lidocaine and prilocaine before laser-assisted hair removal: about 3 cases

  • Weniko CaréEmail author
  • Islam-Amine Larabi
  • Jérôme Langrand
  • Chantal Medernach
  • Jean-Claude Alvarez
  • Antoine Villa
Case Report

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.

Keywords

Lidocaine Prilocaine Methemoglobinemia Laser-assisted hair removal Mass spectrometry 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

414_2018_1858_MOESM1_ESM.docx (18 kb)
Supplementary table 1 (DOCX 17 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Centre antipoison et de toxicovigilance de Parishôpital Fernand-WidalParisFrance
  2. 2.Service de médecine internehôpital d’instruction des armées PercyClamartFrance
  3. 3.Laboratoire de toxicologiehôpital Raymond Poincaré, hôpitaux universitaires Paris Ile-de- France OuestGarchesFrance

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