Numbing creams (local anaesthetic creams) such as Emla are licensed for topical anaesthesia before needle children’s immunisations insertions for example before an injection, commonly used before, or to numb the area before superficial skin procedures. Numbing creams became a popular choice for off-license use as tattoo numbing creams. What is the best numbing cream for injection? In this post, I will discuss over the counter availability of numbing products: numbing creams, gels and ointments, which are available from pharmacies. Always read the patient information leaflet for details advice on methods of administration, special warnings, and other important information.
Numbing cream for injections: the main active ingredients
Numbing creams for injection which are available in pharmacies contain local anaesthetics as the main active ingredients. Local anaesthetics used in topical anaesthetic creams include:
• Prilocaine (used together with lidocaine)
How does numbing cream for injections work?
Local anaesthetic creams contain an active ingredient that blocks nerve impulses from the area where it is applied. This prevents pain signals from reaching the brain, thereby numbing the area and reducing pain sensations.
The most common local anaesthetics used in creams are lidocaine and prilocaine. These anaesthetics work by blocking the sodium channels in the nerve endings, which prevents the nerve from transmitting pain signals. This effect is temporary and will wear off after a few hours.
When the cream is applied to the skin, it penetrates the outer layers of the skin and into the deeper layers where it blocks the nerve impulses. The cream is typically applied to the area where a medical procedure will be performed, such as an injection, minor surgery or tattooing, to reduce the pain associated with the procedure.
Numbing creams are generally effective at relieving pain, however, they require an early application before any procedure takes place (Alster, 2013).
Where can you buy numbing cream for injections?
Any numbing cream, gel or ointment which contains a local anaesthetic is licensed as a pharmacy-only medicine (P). P medicines can only be purchased from chemists and registered online pharmacies. Numbing creams are usually kept in the dispensary and not displayed to the public.
What numbing creams can be purchased from the pharmacy?
- Emla cream
- LMX4 cream
- Ametop gel
- Lidocaine ointment
Emla 5% cream (2.5% lidocaine, 2.5% prilocaine)
EMLA numbing cream is the most popular numbing cream requested by the public and prescribed by GPs. EMLA cream is a topical anaesthetic cream that contains a combination of two local anaesthetics, lidocaine and prilocaine.
EMLA cream works by blocking the nerve signals that transmit pain sensations from the skin or mucous membrane to the brain. This reduces or eliminates the feeling of pain during the medical procedure.
EMLA cream: age restriction
EMLA numbing cream is licensed for newborn infants 0-2 months and all other age groups of children and adults. EMLA cream should not be used at less than 37 weeks of gestational age (eMC, 2019).
EMLA cream is available as a 5g tube, a dispensing pack (no dressing) or as an EMLA OTC cream pack which contains a 5g tube and two occlusive dressings.
What dressing should be used with EMLA cream?
Two dressings included in the OTC pack are 3M Tegaderm dressings (6 cm x 7 cm). Some pharmacies may be able to supply Tegaderm dressings separately when non-OTC Emla cream is purchased or prescribed by GP. Tegaderm dressings for EMLA cream can be purchased online, for example on Amazon.co.uk.
How much does EMLA cost?
Dispensing packs of EMLA numbing cream (no dressing) are slightly cheaper than the OTC pack. The price will vary between pharmacies, but you should pay around £4 for individual numbing cream, and around £5 for the Emla OTC pack.
How and when to apply Emla cream?
• The cream is applied to the skin surface and left for a period of time, typically 30 to 60 minutes, depending on the intended use and the amount of cream applied. Check product information leaflet for applications before other procedures.
• ½ of the tube is applied to the area. Emla should not be rubbed in.
• Adhesive Tegaderm dressing should be applied to the area.
• The dressing should be left in place for at least 60 minutes.
• After 60 minutes (and a maximum of 5 hours, depending on the age), the dressing should be removed, and the area cleaned with alcohol before the procedure.
2. Nulbia 5% numbing cream for injections
Nulbia cream is another brand of a local anaesthetic cream. Nulbia cream contains two active ingredients lidocaine (2.5%) and prilocaine (2.5%). It is the same combination of local anaesthetic ingredients which is found in EMLA cream.
Nulbia cream can be used in children (including infants) and adults. Nulbia cream comes in different sizes with 5g being the most popular. Nulbia cream is not usually stocked by pharmacies but can be ordered from main pharmaceutical suppliers. Nulbia cream is priced similarly to EMLA cream.
3. LMX4 numbing cream for injections (4% lidocaine cream)
LMX4 contains lidocaine as the main active ingredient. LMX4 numbing cream is licensed for children over 1 month of age.
LMX4 cream should be applied at least 30 minutes before the skin procedure.
How much does LMX4 cream cost?
LMX4 numbing cream for injections costs around £5 per 5g tube without dressing.
4. Ametop gel (4% Tetracaine)
Ametop gel is a topical anaesthetic gel that contains the active ingredient tetracaine. Tetracaine is a local anaesthetic medication that is commonly used to numb the skin. Ametop is available in the gel formulation add comes in a 1.5g tube.
Ametop is licensed for children over 1 month of age. Ametop numbing gel is not recommended for infants under 1 month of age.
Ametop gel should be applied 30-45 min before the skin procedure. Longer applications are not necessary.
Ametop gel is kept in the fridge, although it may be stored for up to 1 month at 25°C before use.
Ametop gel is cheaper than above-numbing creams with a price of around £2 per tube (keep in mind Ametop’s smaller size).
5. Lidocaine ointment 5%
A generic form of lidocaine ointment can be purchased from pharmacies. Lidocaine ointment is a local anaesthetic preparation with different licensed use in children and adults:
- A local anaesthetic for the skin
- A local anaesthetic of gums in dentistry
- Management of pain and itchiness associated with haemorrhoids, and herpes zoster infection (shingles)
- For symptomatic relief of sore nipples in nursing mothers
How much does lidocaine ointment cost?
Lidocaine ointment is only available in one size. 15g tube costs around £17-£20.
What is the difference between cream and ointment?
Ointments are thicker and greasier than creams, take longer to absorb, and are better suited for treating dry or scaly skin conditions. Creams are lighter and better suited for milder skin conditions and are easier to apply and absorb more quickly.
What is the best numbing cream for injections?
A systemic review of 25 randomised controlled trials (over 2000 patients) concluded that Emla cream may be effective as non-invasive topical anaesthesia. This research paper also concluded that other numbing products such as LMX and Ametop are as effective (Eidelman et al, 2005).
Can you use a numbing cream before children’s immunisations?
Topical numbing creams can be used before children’s vaccinations. Numbing cream will decrease the pain of needle insertion but will not take the pain completely away.
Can you buy numbing cream for a tattoo procedure?
Licensed use of all the above numbing products is associated with medical procedures. Customers requesting numbing creams for applications before the tattoo procedure will most likely be refused the sale as this is an unlicensed use of the product.
Alster Tina (2013). Review of Lidocaine/Tetracaine Cream as a Topical Anesthetic for Dermatologic Laser Procedures. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4107876/ Accessed on 12/03/2023
Eidelman Anthony (2005). Topical Anesthetics for Dermal Instrumentation: A Systematic Review of Randomized, Controlled Trials. Annals of Emergency Medicine, Volume 46, Issue 4, 343 – 351 Available at: https://doi.org/10.1016/j.annemergmed.2005.01.028 Accessed on 12/03/2023
eMC (2019). SmPC: Emla cream. Available at: https://www.medicines.org.uk/emc/product/871/smpc Accessed on 12/03/2023