We have had numerous requests from shop customers for the purchase of topical
anaesthetics and to assist our customers we shall clarify some of the issues
pertaining to supply;
Some of the common ingredients that may be found in topical
anaesthetics include Lignocaine (Lidocaine), Amethocaine (Tetracaine),
Benzocaine, Prilocaine and the vasoconstrictor Adrenaline (Epinephrine). The supply of those
substances are regulated under the
Therapeutic Goods Act 1989 and section 52D(2)(b) of the act refers to the
Poisons Standard, at the time of writing the current standard is the
The common ingredients within topical anaesthetics, as listed above, that have concentrations of 2 - 10% are classified under Schedule 2 of the Poisons Standard 2010, and under
Schedule 3 in mixtures containing epinephrine with concentrations of 0.02 - 1%.
Products that have less than these concentrations are unlikely to have any significant
benefit during cosmetic tattooing procedures and above those concentrations they would
be classified under Schedule 4.
What do the schedules mean?
Schedule 2 (S2). Pharmacy Medicine – Substances, the safe use of which
may require advice from a pharmacist and which should be available from a
pharmacy or, where a pharmacy service is not available, from a licensed person.
In most situations Schedule 2 means only available from a pharmacy except for in
remote locations where there is no pharmacy a suitable person might be granted a
special license for the supply of some S2 products where there is a legitimate
Schedule 3 (S3). Pharmacist Only Medicine – Substances, the safe use of
which requires professional advice but which should be available to the public
from a pharmacist without a prescription.
In most situations Schedule 3 means only available
from a pharmacist (but without the need for a doctors prescription).
Schedule 4 (S4). Prescription Only Medicine, or Prescription Animal
Remedy – Substances, the use or supply of which should be by or on the order of
persons permitted by State or Territory legislation to prescribe and should be
available from a pharmacist on prescription.
In most situations Schedule 4 means only available
via a doctors prescription and dispensed by a pharmacist, or other persons
authorised by the relevant State or Territory laws.
Quite simply this means that products that are likely to have any beneficial
use in cosmetic tattooing are at least going to be classified under Schedule 2
or 3 of the Poisons Standard and therefore need to be supplied by a
Is Emla a suitable topical anaesthetic to use
prior to cosmetic tattooing?
Emla is not a suitable topical anaesthetic to
use prior to Cosmetic Tattooing because its PH
is quite alkaline and particularly using it near the eye could cause
damage to the sight of the client. It is best practice to always ensure that
topical anaesthetics are PH safe. It is also conceivable that pigment colour
changes could occur due to chemical interaction with an alkaline cream.
What about products that contain the ingredients
Prilocaine and Benzocaine?
A review published by the International Anesthesia
Research Society in 2009 found that of 242 reported cases of anaesthetic related
Methemoglobinemia found within the medical literature since the year 2000,
105 were related to Benzocaine used alone, 44 were related to Prilocaine used
alone and only 10 were related to Lidocaine used alone, just 1 was related to
Tetracaine. The conclusion of the review was that Benzocaine should no longer be
It is reasonable to conclude from the review that
there is significantly less risk of a client/patient developing
Methemoglobinemia with preparations containing Lidocaine and or Tetracaine than
with preparations containing Prilocaine and or Benzocaine.
What about the using occlusive wraps, external
heating, and ultrasonic stimulators to increase absorption?
These methods should not be used as they can increase the amount of anaesthetic
entering the blood stream and could lead to heart block, seizures or even cardiac arrest,
as has been the case with a number of recorded cases within the medical
literature. The Food and Drug Administration of the United States Department of
Health And Human Services had such concern over the improper use of topical
anaesthetics, such as the use of occlusive wraps and external heating, that in
2009 they issued an open letter to health professionals urging caution.
General Precautions When Using Topical
We suggest that all Cosmetic Tattooists read the exceptional publication "Topical
Anaesthetics & Cosmetic Procedures" available on
it is the most comprehensive industry publication in relation to the use of
anaesthetics that we encountered and is recommended reading.
Products within Australia
If you are
already an approved 'Active CT-Shop Customer'
Click Here for the contact details of a pharmacist who can provide
further advice about topical anaesthetics.
In general terms when using topical anaesthetics during a Cosmetic Tattooing procedure it is
important to ensure that;
• You obtain the products from a legal source.
• The products are clearly labelled with the active ingredients and
• You use a suitable anaesthetic for the specific procedure.
• The products are PH
safe, especially if used anywhere near the eye!
• You are following the manufacturers/suppliers instructions.
• The client does not have any medical condition that may preclude the use.
• You check that the client does not have any allergy or sensitivity to any
• You are aware of any possible side effects.
• You are complying with your local laws & regulations.
• You are using the products safely.
Each state and territory also have their own acts which should also
Health (Drugs and
Poisons) Regulation 1996
New South Wales
Therapeutic Goods Regulation 2008
Drugs, Poisons and
Controlled Substances Act 1981
Poisons Act 1971
Australian Capital Territory
and Therapeutic Goods Act 2008
(Poisons) Regulations 1996
Poisons Act 1964
Poisons & Dangerous Drugs Act
1. Eaglstein, NF. Chemical injury to the eye from EMLA cream during erbium laser
resurfacing. Dermatol Surg. 1999 Jul;25(7):590-1.
2. Guay, Joanne. Methemoglobinemia related to local anesthetics a summary of 242
episodes. Anesthesia and analgesia 838 Vol. 108, No. 3, March 2009: 1526-7598.
3. Ohzeki K, Kitahara M, Suzuki N, Taguchi K, Yamazaki Y, Akiyama S, Takahashi
K, Kanzaki Y. Local anesthetic cream prepared from lidocaine-tetracaine eutectic
mixture. Yakugaku Zasshi. 2008 Apr;128(4):611-6.
4. Carruthers, J. Alastair; Carruthers, Jean D.A.; Poirier, Judith; Oliff,
Heather S.; Mordaunt, Julie; Schreiber, William E. Safety of Lidocaine 15 % and
Prilocaine 5 % Topical Ointment Used as Local Anaesthesia for Intense Pulsed
Light Treatment. Dermatologic Surgery 36 (7): 1130-1137, 2010.
5. Lambertz CK, Johnson CJ, Montgomery PG, Maxwell JR. Premedication to reduce
discomfort during screening mammography. Radiology. 2008 Sep;248(3):765-72. Epub
2008 Jul 22.
6. Toigo, Theresa. USA Food and Drug Administration Topical Anaesthetics
Stakeholder Letter January 16, 2009.
7. Australian Therapeutic Goods Act 1989 & Poisons Standard 2010
NB: This is not an advertisement for any product nor
any form of therapeutic treatment it is merely a discussion of some of the
issues that prevent us from supplying topical anaesthetics.
Last Updated: 18/03/2011
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