Lack of Methemoglobin Elevations After Topical Applications of Benzocaine Alone or Benzocaine Plus Tetracaine to the Oral Mucosa

Publication date: Available online 22 September 2017
Source:Clinical Therapeutics
Author(s): Steven Wang, Helen Giannakopoulos, Jamie Lowstetter, Laura Kaye, Catherine Lee, Stacey Secreto, Vanessa Ho, Matthew C. Hutcheson, John T. Farrar, Ping Wang, Geraldine Doyle, Stephen A. Cooper, Elliot V. Hersh
PurposeThis study evaluated changes in methemoglobin and oxygen saturation concentrations after the administration of recommended doses of 14% benzocaine alone or 14% benzocaine combined with 2% tetracaine.MethodsAmerican Society of Anesthesiology class 1 and 2 subjects (n = 40) were enrolled in this modified crossover study. Subjects were administered 0.2 mL of 14% benzocaine alone, 0.2 mL of 14% benzocaine plus 2% tetracaine, or 0.4 mL of 14% benzocaine plus 0.2% benzocaine to their cheek mucosa. Venous blood (5 mL) was drawn from the antecubital fossa before and 60 minutes after drug application for methemoglobin analyses. Oxygen saturation was also recorded via pulse oximetry at baseline and every 10 minutes through 60 minutes after drug application.FindingsMethemoglobin and oxygen saturation levels did not change from baseline after the administration of benzocaine alone or when combined with tetracaine.ImplicationsRecommended doses of benzocaine or benzocaine combined with tetracaine when applied to the cheek mucosa do not induce even clinically insignificant elevations in methemoglobin levels. Metered dosing, such as that used in this study, can help avoid this overdose phenomena with these drugs. ClinicalTrials.gov identifier: NCT02908620.



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