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Topical Local Anaesthetic (Neuropathic Pain) Pregnancy: Use with caution — minimal systemic absorption; not expected to cause fetal harm at licensed doses; consult specialist

Lidocaine 5% Medicated Plaster

Brand names: Versatis

Adult dose

Dose: 1–3 plasters applied to painful area for 12 hours on, 12 hours off
Route: Topical applied to intact non-inflamed skin
Frequency: 12 hours on, 12 hours off — maximum 3 plasters simultaneously
Max: 3 plasters per 12-hour application period
Do NOT apply to broken, irritated, or inflamed skin; avoid mucosal surfaces; systemic absorption approximately 3% of total dose; can be cut to size; licensed for postherpetic neuralgia; widely used off-label for localised OA, back pain, CRPS

Paediatric dose

Route: N/A
Frequency: N/A
Max: Not licensed under 18 years
No paediatric licence

Dose adjustments

Renal

No adjustment required (minimal systemic absorption)

Hepatic

Use with caution in severe hepatic impairment — lidocaine hepatically metabolised; systemic absorption low

Clinical pearls

  • Licensed indication in UK: postherpetic neuralgia in adults — NICE TA159; off-label use widespread and evidence-supported for OA knee pain, chronic low back pain, shoulder pain, and CRPS type I
  • OA knee and localised joint pain: EFLA94 trial and subsequent meta-analyses demonstrate non-inferior efficacy to oral NSAIDs for localised OA with significantly fewer systemic side effects — particularly valuable in elderly patients with GI, renal, or cardiovascular contraindications to oral NSAIDs
  • MHRA 2018 update: no systemic QTc prolongation at licensed doses; blood lidocaine levels remain well below cardiotoxic threshold (>5 mcg/mL) even with 3 plasters — safe for patients on antiarrhythmics or with cardiac disease
  • Mechanism: peripheral sodium channel blockade at dermal nociceptors and cutaneous afferent fibres — reduces allodynia and hyperalgesia without anaesthesia; works at subanaesthetic concentrations
  • CRPS type I: lidocaine plaster reduces allodynia applied over the affected limb — adjunct to physiotherapy and multimodal pain management; British Pain Society guidelines support off-label use in CRPS

Contraindications

  • Application to broken or inflamed skin
  • Allergy to lidocaine or amide local anaesthetics
  • Application near mucous membranes

Side effects

  • Local skin reactions erythema or oedema (~20%, usually mild)
  • Contact dermatitis (rare)
  • Systemic effects minimal at licensed doses

Interactions

  • Antiarrhythmic drugs — theoretical additive cardiac effects (clinically rare due to low systemic absorption)
  • Other local anaesthetics — additive toxicity if applied to large areas of compromised skin

Monitoring

  • Pain score (NRS) at 4–8 weeks to assess response
  • Skin condition at application site
  • Systemic lidocaine symptoms only if applied to large areas of damaged skin

Reference: BNFc; BNF 90; NICE TA159 (Lidocaine Plaster for PHN); MHRA SPC Versatis; EFLA94 trial; British Pain Society Guidelines; NICE NG59. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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