Methemoglobinemia is an uncommon but important complication associated with the use of topical anesthetics. We describe four cases of methemoglobinemia induced by topical benzocaine use. We review pathophysiology, early diagnosis, and therapy for this reversible yet potentially fatal condition. Physicians who use procedures involving the application of topical anesthetics need to be aware of this side effect to prevent significant morbidity and mortality.
Benzocaine is used topically in the external auditory canal for the temporary relief of ear pain. Topical anesthetics may provide symptomatic relief, but they do not preclude the need for appropriate anti-infective therapy when ear pain is secondary to infection. The efficacy of benzocaine for relief of ear pain has not been established.
Benzocaine also is used topically on oral mucous membranes in the form of aerosols, gels, pastes, or solutions for local anesthesia. The drug is used in the form of a gel on nasopharyngeal mucosa and intratracheal catheters. Benzocaine also is used in the form of oral lozenges for the temporary relief of minor sore throat pain or in the form of various topical aerosols, gels, or solutions for the temporary relief of pain associated with various dental conditions (e.g., toothache, sore gums, denture irritation, teething).
Benzocaine is used topically alone or with other anesthetics in the form of aerosols, gels, and solutions as a local anesthetic agent prior to surgical, endoscopic, or other procedures.
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