Topical Lidocaine –L.M.X. 4
The staff at AFCH and UWHC wants you and your child to have the best possible health care
experience. Many parents and children fear the pain and anxiety related to a poke or needle stick.
Topical lidocaine is a cream that can be applied to numb the skin. L.M.X.4 is one of these
creams. This handout will teach you how to use L.M.X.4 to reduce or prevent the pain that often
comes with needle sticks.
Tips for using L.M.X.4
ξ Apply L.M.X.4 to the area that your child will receive a needle stick just before leaving
home for doctor or hospital visits. If you live more than one hour away, you may want to
wait and apply the cream when you arrive for your visit.
ξ Do NOT clean the site before you apply the cream. L.M.X.4 works with the oils in the
skin. If the skin is very dirty, wash the area with soap and water.
ξ For the best pain relief, L,M.X. 4 should be on the skin at least 20-30 minutes.
ξ The cream can remain on the skin for up to 60 minutes.
ξ The numb feeling will last for up to 90 minutes after the cream has been wiped away.
ξ L.M.X.4 should be stored at room temperature. Keep it out of the reach of small
ξ Each small tube (15 gram) contains enough medicine for 2 – 4 uses. Throw the tube
away when it has expired.
ξ Use only on skin that is intact and without wounds or rashes. Intact skin means that the
skin has no open spots, redness, or wounds. Do not use L,M.X.4 on lips, mouth or
How much does L.M.X. 4 cost and where can I buy it?
As with any over the counter drug purchased at a pharmacy, it varies by pharmacy. UWHC
Pharmacies have priced this product competitively and keep the product on hand for patient
convenience. You may ask about current prices from any UWHC Health Pharmacy.
Will Insurance Companies pay for L.M.X.4?
A few insurance companies will cover it. It depends on the plan. You can call your plan in
advance to ask if they will cover it.
How do I apply the cream?
1. While wearing gloves, rub a small amount of cream to the area the needle will go in. Rub
into the skin for about 30 seconds. If you do not have gloves, rinse your hands under
running water after applying the cream. Do not use soap or alcohol gels. This may
increase the amount you absorb. If you are not sure which site will be used, you can call
and ask the nurse which site or sites will be used. You can ask when you arrive for your
visit and apply the cream at that time.
a. Most likely places for a needle stick:
Infant up to 5 years 2 year old and older
2. Apply more L.M.X.4 to cover an area about the size of a nickel. This layer should be
thick like frosting on a cake.
3. The cream does not need to be covered in order for it to work. You can use “press and
seal” clear plastic wrap to keep the cream in place if a dressing did not come with the
cream. If you do not have “press and seal”, use any brand of clear plastic wrap. Wrap it
loosely around the arm or leg and secure with some clear tape. Do not apply the clear
wrap too tightly or it will decrease the flow of blood to fingers or toes. Do not use heat
or cold on the site as this can change how much medicine is absorbed.
Are there side effects with L.M.X. 4?
All medicines have side effects. Some are mild and do not need to be reported to your doctor,
▪ Short-term blanching (whitening) of the skin where the cream was put. Later the
blanching may change to redness.
▪ Itching at the site.
If you notice any changes in behavior or have any concerns, remove the cream from the skin
right away. Then, call the doctor’s office and ask to speak to your child’s doctor or nurse. After
hours, ask for the doctor on call.
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright ©11/2015. University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#6836.