title: Comparison of lidocaine/tetracaine cream and lidocaine/prilocaine cream for local anaesthesia during laser treatment of acne keloidalis nuchae and tattoo removal: results of two randomized controlled trials.
abstract: BACKGROUND
  Pain is a common adverse effect of dermatological laser procedures. Currently, no standard topical anaesthetic cream exists for deeper dermal laser procedures.
  
  
  OBJECTIVE
  To compare the efficacy of lidocaine/tetracaine cream and lidocaine/prilocaine cream in reducing self-reported pain during deeper dermal laser treatment of acne keloidalis nuchae (AKN) and tattoos.
  
  
  METHODS
  We conducted two randomized, double-blind, controlled clinical trials with intrapatient, split-lesion designs: study A included patients with AKN (n = 15); study B included patients with black tattoos (n = 15). The primary end point was the patients' self-reported pain on a 10-cm visual analogue scale (VAS). Secondary objectives were the percentage of patients with adequate pain relief, willingness to pay €25 for the cream that provided the best pain relief and safety of the creams.
  
  
  RESULTS
  In both studies, VAS scores were lower for lidocaine/prilocaine cream, with a mean VAS difference in study A of 1·9 [95% confidence interval (CI) 1·0-2·8] and in study B of 0·6 (95% CI -0·7 to 1·9). In study A, adequate pain relief was achieved in 13% (n = 2) with lidocaine/tetracaine cream vs. 73% (n = 11) with lidocaine/prilocaine cream (P = 0·004), and in study B in 53% (n = 8) vs. 80% (n = 12), respectively (P = 0·289). In study A, 47% (n = 7) were willing to pay an additional €25 vs. 73% (n = 11) in study B. No serious adverse events occurred.
  
  
  CONCLUSIONS
  Lidocaine/prilocaine cream under plastic occlusion is the preferred topical anaesthetic during painful laser procedures targeting dermal chromophores.
authors.affiliation: Department of Dermatology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Greveling
authors.affiliation: Department of Dermatology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands.
authors.forename: E P
authors.initials: EP
authors.lastname: Prens
authors.affiliation: Department of Dermatology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Ten Bosch
authors.affiliation: Department of Dermatology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands.
authors.forename: M B
authors.initials: MB
authors.lastname: van Doorn
mesh_terms: D000153:Acne Keloid / Q000628:therapy*; D059787:Acute Pain / Q000517:prevention & control*; D000328:Adult; D019162:Anesthetics, Combined / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D003357:Cosmetic Techniques; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects* / Q000379:methods; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D011318:Prilocaine / Q000008:administration & dosage; D013653:Tattooing; D013748:Tetracaine / Q000008:administration & dosage
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D011318:Prilocaine; D013748:Tetracaine; D008012:Lidocaine