This leaflet is for patients who have undergone reconstructive breast surgery. It answers common questions about the use of lidocaine 2.5% / prilocaine 2.5% cream, which is a medicine used to numb the skin before micropigmentation, also known as medical tattooing.

Before carrying out any procedure or treatment, we will seek your consent. Staff will explain the procedure or treatment to you, along with the associated risks, benefits and alternatives before they ask you for your consent.

If you would like further information, or have any particular questions, please do not hesitate to ask your nurse, doctor or pharmacist. In most cases it will be possible for a friend or relative to accompany you for all or part of the procedure. Please ask your healthcare practitioner.

What is lidocaine 2.5% / prilocaine 2.5% cream?

Lidocaine 2.5% / prilocaine 2.5% cream is a type of medicine known as a local anaesthetic. It is a soft white cream and contains active ingredients lidocaine and prilocaine. These ingredients numb the skin to stop pain before, and during, procedures such as medical tattooing.

What you need to know before using the cream?

Do not use the cream if you are allergic to lidocaine or prilocaine, or any of the ingredients in the medicine.

Tell your nurse, doctor or pharmacist if you have any of the following conditions:

  • glucose-6-phosphate dehydrogenase deficiency – a rare blood condition
  • methaemoglobinaemia – a condition which raises blood pigment levels
  • atopic dermatitis – a skin condition which causes itching
  • if you take medication for heart rhythm disorders (class III antiarrhythmics), for example amiodarone.

You should also not do the following:

  • Use the cream on open wounds or areas on the skin where there is a rash, cut or graze.
  • Get the cream in your eyes. It may cause irritation and you should wash it out immediately with water or salt water solution (sodium chloride).
  • Get the cream inside your ears. It may harm the eardrum.

If you are taking other medications Tell your nurse, doctor or pharmacist if you are taking any other medications, both prescription and herbal. If you are taking other medications while using lidocaine 2.5%/prilocaine 2.5% cream, it may not work effectively.

It is particularly important to tell your nurse, doctor or pharmacist if you take the following medications:

  • sulphonamides and nitrofurantoin to treat infections
  • phenytoin and phenobarbital to treat epilepsy
  • other local anaesthetics
  • medicines to treat an irregular heartbeat such as amiodarone
  • cimetidine or beta blockers as they may cause lidocaine blood levels to increase, but not in short term use of the cream.

How to use lidocaine 2.5% / prilocaine 2.5% cream before micropigmentation

Your nurse or doctor will advise you how to apply the cream before the micropigmentation procedure, as follows:

  1. Apply the cream to one or both of your breasts one hour (maximum five hours) before medical tattooing.
  2. A dose of 1.5g will cover a 10cm² area of skin. This is approximately half a 5g tube of cream.
  3. You may find it easier to stand in front of a mirror before applying the cream.
  4. Squeeze out the required amount of cream onto the reconstructed breast skin.
  5. Peel off the backing of the dressing supplied and place it sticky side down directly on top of the cream.
  6. The cream should flatten down under the dressing to cover the area to be tattooed.
  7. Finally, remove the top layer of the dressing. This dressing can stay on for up to five hours before medical tattooing.

What to do if too much cream is used?

If you apply more cream than the required dose, tell your nurse, doctor or pharmacist as soon as you can. The following symptoms are associated with using too much cream:

  • light headed or dizziness
  • tingling of skin and numbness of tongue
  • abnormal taste
  • blurred vision
  • ringing in the ears.

Be aware of potential side effects

Not everyone will experience side effects to the cream. But if you do, contact your nurse, doctor or pharmacist immediately. Mild reactions are normal and usually do not last long such as paleness or redness of skin, slight swelling, burning or itching.

In rare cases (1 in 1000 people), you may have an allergic reaction, leading to anaphylactic shock (skin rash, swelling, fever, breathing problems and fainting) or develop the blood disorder methaemoglobinaemia.

It can also irritate the eyes as a result of accidental contact during skin treatment.

What does lidocaine 2.5%/prilocaine 2.5% cream contain?

The cream contains the active ingredients lidocaine and prilocaine. Each gram of cream has 25mg of lidocaine and 25mg of prilocaine.

Other ingredients are:

In EMLA® cream

  • macrogolglycerol hydroxystearate
  • Carbomer 974P
  • sodium hydroxide
  • purified water.

In Nulbia® cream

  • Castor oil polyoxyl hydrogenated
  • Carbomer 974P
  • sodium hydroxide
  • purified water.

How to store lidocaine 2.5%/prilocaine 2.5% cream

  • Keep the cream away from children.
  • Store at room temperature.
  • Do not store above 30°C and do not freeze.
  • Do not use after the expiry date.
  • Do not throw away in household waste or waste water.
  • Ask your nurse, doctor or pharmacist how to dispose of this medicine responsibly.

Useful contacts

Plastic surgery out-patient clinic 4: Tel: 020 7794 0500, extension 31312