Topical Anaesthetics

Using the correct pre-procedure and during the procedure numbing creams is very important to keep your client as comfortable as possible. Pre-numbing will work to a point, but once the skin has been broken in the first pass procedure, numbing will be much more effective and faster as it will reach the bloodstream immediately.

During the procedure ask your client if they are feeling comfortable.  Apply the cream on one brow as you are working on the other brow. It is important to use only topical anaesthetics that are suitable for cosmetic tattooing. You may need a prescription to make sure you are complying with your State and Commonwealth Laws and Regulations. You can check with your local Council regarding their requirements for your area.

The topical anaesthetics that are used in cosmetic tattooing will be classified under Schedule 2 or 3 of the Poisons Standard and therefore need to be supplied by a compounding pharmacist or pharmacy. For procedure numbing we use a local compounding pharmacy to make up a cream that contains regulated ingredients in Victoria, including epinephrine to control bleeding.

We prefer to use Zensa for our pre-procedure numbing process
https://zensaskincare.com

Some states in Australia have different guidelines when it comes to purchasing a compounding pharmacy cream containing the above ingredients. You may need your client to organise a script, and to purchase their own numbing cream for the procedure. 

Use of under the counter anaesthetics is Illegal and can be a risk to your client’s health. If you are unsure and need advice in relation to these products contact a medical practitioner or pharmacist. 

Make sure your clients are aware that they need to avoid Aspirin or Ibuprofen, alcohol, and a heavy intake of caffeine for at least 48 hours before the procedure.

If your client is on serious medication for any serious illnesses such as Aspirin or Warfarin or other medications DO NOT ask them to discontinue use without doctor consent, and obtain a medical certificate signed by their doctor. Any illness that may be a contraindication (risks) for cosmetic tattooing needs a doctor’s written approval.

Most topical anaesthetics contain lidocaine, tetracaine, epinephrine or sulphur, therefore you will need to ask clients if they have any allergies to these substances. Other than topical anaesthetics, clients may also have allergies to pigments. To ensure their safety, it is important to also ask if they have any allergies to nickel, jewellery or hair dyes. If they do, you will need to proceed with a patch test. This will be explained further.

Always ask your client if they have any medical conditions and if unsure ask them to seek medical advice. 

It is important to ensure that:

  1. You obtain topical anaesthetics from a legal source i.e. a compounding pharmacy
  2. The ingredients and concentrations are clearly labelled on the product
  3. The products are PH safe (Potential of Hydrogen i.e. a measure of acidity or alkalinity)
  4. You are following the manufacturer’s instructions
  5. The client does not have any medical conditions or allergies 
  6. Clients who are hormonal or fatigued will experience more pain, and every day everyone’s pain tolerance will change.
  7. You are complying with your local laws and regulations
  8. You are using the product safely in a sterile environment
  9. You are familiar with the Therapeutic Goods Act 1989 and the current Poisons standards (if in doubt, contact the Therapeutic Goods Administration).

A review published by the International Anaesthesia Research Society in 2009 reported 242 cases of anaesthetic related Methemoglobinemia, which is a potentially life-threatening blood disorder. 

105 cases were related to Benzocaine alone, therefore Benzocaine should no longer be used. 44 cases were related to Prilocaine and only 10 to Lidocaine and 1 to Tetracaine. In conclusion, preparations with Lidocaine and Tetracaine are safer and can be used as topical anaesthetics before and during a cosmetic tattoo. 

Symptoms of Methemoglobinemia may include a bluish/brownish skin colouring, headache, fatigue, shortness of breath, irregular heartbeat, seizures, and loss of energy. 

Do not apply topical anaesthetics to large surfaces of the skin or to areas where skin conditions exist. Topical anaesthetic needs to be applied with a sterile cotton tip at least 20 minutes before the procedure to ensure maximum comfort. 

Side effects:

The client should seek medical attention if any of the following symptoms occur after the application of topical anaesthetics.

  1. Abnormally constricted or dilated pupils
  2. Local skin irritation or rash
  3. Bluish/brownish coloration of the skin
  4. Light headed or dizziness
  5. Blurred vision
  6. Tingling around the mouth
  7. Loss of energy
  8. Anxiety, confusion, tremors, fainting or seizures
  9. Irregular heartbeat 
  10. Difficulty breathing