Review of a New Topical Anesthetic, Liposomal Lidocaine, for Procedural Pain in Children
Bibliographic record
Abstract
The introduction of the topical local anesthetic cream EMLA (a eutectic mixture of the local anesthetics lidocaine and prilocaine) revolutionized the management of procedural pain in children. Since lidocaine‐ prilocaine was first launched over 10 years ago, several other topical anesthetics have become commercially available for use in children, including liposomal lidocaine, the subject of this article. The pharmacologic profile of liposomal lidocaine offers several advantages over lidocaine‐prilocaine, including faster onset of action and fewer adverse effects. This drug is currently available in Canada and the United States under the trade names Maxilene 4 (RGR Pharma, Windsor, Ontario) and LMX (formerly ELA-Max; Ferndale Laboratories, Ferndale, Michigan), respectively. Maxilene 4 is a liposomal encapsulated formula containing 4% lidocaine. Liposomal encapsulation involves the use of lipid bilayers to rapidly deliver the lidocaine into the dermis of the skin. The liposome protects the lidocaine molecule from metabolic processes and from removal by blood circulation and acts as a depot in the epidermis for prolonged release of the drug. 1 The rate at which lidocaine is released into the dermis depends on the stability and permeability of the lipid bilayer in the skin environment. After release, the lidocaine accumulates in the vicinity of pain receptors and nerve endings, where it exerts its local anesthetic action. It stabilizes neuronal membranes by inhibiting the ionic fluxes required for the initiation and conduction of impulses. The onset, depth, and duration of dermal analgesia depend primarily on the duration of application. 1
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.008 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".