title: Serum lidocaine levels and cutaneous side effects after application of 23% lidocaine 7% tetracaine ointment to the face.
abstract: BACKGROUND
  Few published studies have analyzed serum lidocaine levels and individual patient characteristics affecting metabolism after application of compounded topical anesthetics.
  
  
  OBJECTIVE
  To measure serum lidocaine levels during and cutaneous side effects after standardized application of 23% lidocaine/7% tetracaine compounded anesthetic to the face of healthy volunteers.
  
  
  METHODS
  Fifty-two volunteers were enrolled, and compounded 23% lidocaine/7% tetracaine ointment was applied to their faces for 2 hours. Lidocaine levels were determined every 30 minutes during application and for 2 hours after removal. Follow-up telephone calls 3 days later assessed cutaneous side effects.
  
  
  RESULTS
  Median peak lidocaine level was 1.15 μg/mL, and the highest peak lidocaine level in an individual was 3.4 μg/mL. Higher serum lidocaine levels were found in men (p < .01), nonwhite volunteers (p = .02), and those with larger facial surface area (p = .04). Age and body mass index did not affect lidocaine levels. Irritant contact dermatitis was common, resulting in hyperpigmentation in some patients.
  
  
  CONCLUSIONS
  Facial surface area, male sex, and nonwhite ethnicity were associated with higher serum lidocaine levels after topical application of lidocaine. Compounded anesthetics containing lidocaine should be used with caution under the direct supervision of a physician.
authors.affiliation: Department of Dermatology, David Grant Medical Center, Travis Air Force Base, Fairfield, California, USA.
authors.forename: Patrick E
authors.initials: PE
authors.lastname: McCleskey
authors.forename: Seema M
authors.initials: SM
authors.lastname: Patel
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Mansalis
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Elam
authors.forename: Tina R
authors.initials: TR
authors.lastname: Kinsley
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood*; D001830:Body Surface Area; D003877:Dermatitis, Contact / Q000209:etiology; D004338:Drug Combinations; D003875:Drug Eruptions / Q000209:etiology*; D005145:Face / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D017495:Hyperpigmentation / Q000139:chemically induced; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009823:Ointment Bases; D044469:Racial Groups; D012737:Sex Factors; D013748:Tetracaine / Q000008:administration & dosage / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D004338:Drug Combinations; D009823:Ointment Bases; D013748:Tetracaine; D008012:Lidocaine