A New Method of Topical Anesthesia by Using Anesthetic Solution in a Patch

Published:September 03, 2013DOI:



      We investigated the effects of topical anesthesia of the oral mucosa by using an adhesive patch instilled with 2% lidocaine hydrochloride solution.


      The subjects were 20 healthy adult volunteers who gave written informed consent. Each patient was treated in a randomized crossover fashion with a hemostatic adhesive patch instilled with one of the following agents: 2% lidocaine hydrochloride with 12.5 μg/mL epinephrine, 2% lidocaine hydrochloride, 20% ethyl aminobenzoate, or physiological saline solution. A cotton ball containing 20% ethyl aminobenzoate was also tested. The adhesive patch or cotton ball was placed on the gingivobuccal fold of the maxillary right canine for 2 or 5 minutes. Then, a 33-gauge or 30-gauge needle was inserted to a depth of 2 mm. Insertion pain was evaluated with a visual analog scale (VAS) and a 4-level verbal rating scale immediately after needle removal. Efficacy of analgesia was calculated from the verbal rating scale.


      The VAS was lower and the efficacy of analgesia was higher on 33-gauge needle insertion than on 30-gauge needle insertion in all treatments. The VAS was also significantly lower and the efficacy of analgesia was higher in the lidocaine groups than in the other groups. Adding epinephrine did not enhance the anesthetic effect of lidocaine hydrochloride.


      Topical mucosal anesthesia with an adhesive patch containing 2% lidocaine hydrochloride solution is simple and may be more effective than conventional methods.

      Key Words

      To read this article in full you will need to make a payment


      Subscribe to Journal of Endodontics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Girdler N.M.
        • Smith D.G.
        Prevalence of emergency events in British dental practice and emergency management skills of British dentists.
        Resuscitation. 1999; 41: 159-167
        • Sambrook P.J.
        • Smith W.
        • Elijah J.
        • et al.
        Severe adverse reactions to dental local anaesthetics: systemic reactions.
        Aust Dent J. 2011; 56: 148-153
        • Arsati F.
        • Montalli V.A.
        • Flório F.M.
        • et al.
        Brazilian dentists’ attitudes about medical emergencies during dental treatment.
        J Dent Educ. 2010; 74: 661-666
        • Corbett I.P.
        • Ramacciato J.C.
        • Groppo F.C.
        • et al.
        A survey of local anaesthetic use among general dental practitioners in the UK attending postgraduate courses on pain control.
        Br Dent J. 2005; 199: 784-787
        • Nusstein J.M.
        • Beck M.
        Effectiveness of 20% benzocaine as a topical anesthetic for intraoral injections.
        Anesth Prog. 2003; 50: 159-163
        • Bhalla J.
        • Meechan J.G.
        • Lawrence H.P.
        • et al.
        Effect of time on clinical efficacy of topical anesthesia.
        Anesth Prog. 2009; 56: 36-41
        • Hersh E.V.
        • Houpt M.I.
        • Cooper S.A.
        • et al.
        Analgesic efficacy and safety of an intraoral lidocaine patch.
        J Am Dent Assoc. 1996; 127: 1626-1634
        • Houpt M.I.
        • Heins P.
        • Lamster I.
        • et al.
        An evaluation of intraoral lidocaine patches in reducing needle-insertion pain.
        Compend Contin Educ Dent. 1997; 18 (312–4, 316): 301-309
        • Gangarosa Sr., L.P.
        Iontophoresis for surface local anesthesia.
        J Am Dent Assoc. 1974; 88: 125-128
        • Malamed S.F.
        What’s new in local anesthesia?.
        Anesth Prog. 1992; 39: 125-131
        • Tharian E.B.
        • Tandon S.
        Iontophoresis: a novel drug administration for extraction of deciduous teeth—a clinical evaluation.
        Indian J Dent Res. 1994; 5: 97-100
        • Dabarakis N.N.
        • Alexander V.
        • Tsirlis A.T.
        • et al.
        Needle-less local anesthesia: clinical evaluation of the effectiveness of the jet anesthesia Injex in local anesthesia in dentistry.
        Quintessence Int. 2007; 38: 572-576
        • Ganzberg S.
        • Kramer K.J.
        The use of local anesthetic agents in medicine.
        Dent Clin North Am. 2010; 54: 601-610
        • Thyssen J.P.
        • Menné T.
        • Elberling J.
        • et al.
        Hypersensitivity to local anaesthetics: update and proposal of evaluation algorithm.
        Contact Dermatitis. 2008; 59: 69-78
        • Al-Melh M.A.
        • Andersson L.
        Comparison of topical anesthetics (EMLA/Oraqix vs benzocaine) on pain experienced during palatal needle injection.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 103: 16-20
        • Bågesund M.
        • Tabrizi P.
        Lidocaine 20% patch vs lidocaine 5% gel for topical anaesthesia of oral mucosa.
        Int J Paediatr Dent. 2008; 18: 452-460
        • Ogasawara T.
        • Sairenji N.
        • Kawase Y.
        • et al.
        A study of the effectiveness of topical anesthetic (60% lidocaine tape) on the oral mucous membrane (in Japanese).
        J Jpn Dent Soc Anesthesiol. 2002; 30: 36-41
        • Hjermstad M.J.
        • Fayers P.M.
        • Haugen D.F.
        • et al.
        Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: a systematic literature review.
        J Pain Symptom Manage. 2011; 41: 1073-1093
        • Collins S.L.
        • Moore R.A.
        • McQuay H.J.
        The visual analogue pain intensity scale: what is moderate pain in millimetres?.
        Pain. 1997; 72: 95-97
        • van Wijk A.J.
        • Makkes P.C.
        Highly anxious dental patients report more pain during dental injections.
        Br Dent J. 2008; 205: 142-143
        • Gordon S.M.
        • Dionne R.A.
        • Snyder J.
        Dental fear and anxiety as a barrier to accessing oral health care among patients with special health care needs.
        Spec Care Dentist. 1998; 18: 88-92
        • Mashu S.
        • Shibaji T.
        • Zeredo J.L.
        • et al.
        Comparison of mechanical pain thresholds among various orofacial areas in humans.
        Pain Res. 2004; 19: 123-131
        • Holst A.
        • Evers H.
        Experimental studies of new topical anaesthetics on the oral mucosa.
        Swed Dent J. 1985; 9: 185-191
        • Nayak R.
        • Sudha P.
        Evaluation of three topical anaesthetic agents against pain: a clinical study.
        Indian J Dent Res. 2006; 17: 155-160
        • Fukayama H.
        • Suzuki N.
        • Umino M.
        Comparison of topical anesthesia of 20% benzocaine and 60% lidocaine gel.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002; 94: 157-161
        • Watanabe T.
        • Koshiba K.
        • Okuda H.
        • et al.
        Comparison of the pain perception induced by intraoral penetration by a new fine needle and a 30-gauge needle (in Japanese).
        J Jpn Dent Soc Anesthesiol. 1995; 23: 19-30
        • Moore P.A.
        • Hersh E.V.
        Local anesthetics: pharmacology and toxicity.
        Dent Clin North Am. 2010; 54: 587-599
        • Parirokh M.
        • Sadeghi A.S.
        • Nakhaee N.
        • et al.
        Effect of topical anesthesia on pain during infiltration injection and success of anesthesia for maxillary central incisors.
        J Endod. 2012; 38: 1553-1556
        • Bjorn H.
        • Huldt S.
        The efficiency of Xylocaine as a dental terminal anesthetic as compared to that of procaine.
        Svensk Tandl Tidskr. 1947; 40: 831-852
        • Thomas C.
        • Westfall D.P.
        Adrenergic agonists and antagonists.
        in: Laurence B. Bruce C. Bjorn K. Goodman & Gilman’s the Pharmacological Basis of Therapeutics. McGraw-Hill, New York2010: 277-334