Prototype: Procaine

Brand Name: Americaine,

Generic Name: Benzocaine topical
Classification: PERINEAL WOUNDS

Recommended Dosage, Route, and Frequency:

Drug Action:

Drug-Drug and Drug-Food Interactions:

Indications:

Contraindications:

Side Effects:

Adverse Reactions:

Nursing Responsibilities:

Assessment

 Assess the patient’s cultural framework for health.

 Assess the patient’s pain using an agency pain scale. Assess the perineal area for wounds and hemorrhoids (size,
color, location, pain scale, REEDA [redness, ecchymosis, edema, discharge, and approximation]).
 Check expiration dates on topical spray cans, bottles, and ointment tubes.
 Assess for presence of infection at the perineal site; avoid use of benzocaine on infected perineal tissue.

Nursing Diagnoses

 Knowledge, Deficient of causes of pain and discomfort; inexperience with treatment measures,
nonpharmacologic and pharmacologic.
 • Pain, Acute related to episiotomy, perineal laceration, or hemorrhoids Planning • The patient’s perineal
discomfort will be alleviated by use of topical sprays, compresses, sitz baths, and ointments. Nursing
Interventions • Teach patients about use of the peri-bottle. Use warm, direct water on the perineum from front
to back (clean to dirty). • Do not use benzocaine spray when perineal infection is present. • Shake the spray can
and administer benzocaine 6 to 12 inches from the perineum with the patient lying on her side, top leg up and
forward, to provide maximum exposure. This can also be done with one foot on the toilet seat. • Use witch hazel
compresses (glycerin and witch hazel or witch hazel solution) with an ice pack and a peri-pad to apply cold to the
affected area in addition to the active agent. • Store pramoxine and zinc oxide topical or hydrocortisone acetate
suppositories below 86°F (30°C), but protect them from freezing. Use gloves for administration. If a patient is
breastfeeding, assess to determine whether the patient is ready to switch to a preparation without
hydrocortisone (the goal is to discontinue use of suppositories as quickly as possible). • Check lot numbers and
expiration dates. • Use of pramoxine hydrochloride (HCl) must be explained carefully; directions instruct the
patient to place the agent inside the anus, which is not generally done with obstetric patients because they may
have perineal wounds that extend into the anus. Rectal suppositories should not be used by patients with
fourth-degree perineal laceration. Patient Teaching General • Describe the process of perineal wound healing. •
Explain the expected action and side effects. With witch hazel, a cooling, soothing sensation will provide relief.
Ointment and suppositories will soothe, lubricate, and coat mucous membranes. Pramoxine HCl is not
chemically related to the “-caine” type of local anesthetics, and there is a decreased chance of cross-sensitivity
reactions in patients who are allergic to other local anesthetics. • Advise patients that the drug is not for
prolonged use (no more than 7 days) or for application to a large area. • Explain that topical analgesia lasts for
several hours after use. • Advise patients to store suppositories below 86°F (30°C) so they do not melt, and do
 not freeze. Counsel the patient with bleeding hemorrhoids to use the drug carefully and to keep their health
care provider informed if the condition exacerbates or does not improve within 7 days. Self-Administration:
Perineal Wounds—Topical Spray Containing Benzocaine • Apply three to four times daily or as directed. • Apply
without touching sensitive areas. • Hold the can 6 to 12 inches from the affected area. Teach the patient to
administer the spray by either lying on her side in bed while spraying from behind or by standing with one foot
on a chair or toilet seat. • Avoid contact of medication with eyes. • Assess use of CAM, including herbal
supplements. • Teach the patient not to use a perineal heat lamp after application because this could cause
tissue burns. • If the condition exacerbates or symptoms recur within a few days, notify the health care provider
and discontinue use until directed. • Keep medication out of children’s reach in the postpartum unit and later in
the home. If ingested, contact a poison control center immediately. • Store below 120°F (49°C). Dispose of
empty cans without puncturing or incinerating

References:

Sanoski and Vallerand (2016). Davis’s Drug Guide for Nurses. 15th Edition. Philadelphia, Pennsylvania: F.A.
Davis Company. Retrieved from file:///C:/Users/valerie%20tumanda/Downloads/Davis%E2%80%99s%20Drug%20Guide
%20for%20Nurses%20(%20PDFDrive.com%20).pdf

Wilson, Shannon & Stang (n.d.) Rob Holland Drug Guide. Retrieved from
http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/V018.html

H E L L O PAKI CHANGE SA NAME NAKO SA REFERENCE