Refrigerant anesthetic sprays such as Ethyl Chloride (chloroethane) and Fluori-Methane (dichlorodifluoromethane, trichloromonofluoromethane) offer another effective and convenient alternative for topical anesthesia. Ethyl Chloride has been used as a local anesthetic for over 100 years. Vaporization of the liquid spray on the skin lowers its temperature to -20°C, thereby temporarily freezing it. Anesthesia is almost immediate, providing a distinct advantage in a busy outpatient clinic or ED over EMLA cream.
Refrigerant anesthetic sprays have been used to reduce pain associated with minor surgical procedures on the skin, abscess incision, deep intramuscular injections (immunizations), lumbar punctures, venous cannulation, bone marrow aspiration, digital blocks, and port access in children. In addition, these vapocoolants have been used to reduce pain associated with athletic injuries, muscle pain, and myofascial pain. This needle-less form of anesthesia offers a clear psychological advantage to a child's perception and anxiety about pain, compared to a needle injection.
Ethyl Chloride can be applied by inverting the bottle and directing a stream of spray about 30 cm from the skin until the area turns white, while protecting the adjacent skin with petrolatum. Alternatively, apply the spray to a sterile cotton ball for 10 s and then apply it to the skin for 10 s. The liquid maintains its sterility and the cost is minimal. Disadvantages includes its short duration of only 30 seconds to 1 minute, superficial level of anesthesia only, possible pain on thawing, possible lowered resistance to infection, and delayed skin healing. Prolonged spraying causes chemical "frostbite" and skin ulceration. These sprays cannot be used on the mucosa. Inhalation should be avoided because it can produce opioid and general anesthetic effects. Ethyl Chloride is flammable and must be used in a well-ventilated room, never in the presence of open flames or electric cautery.
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