Topical anesthetics (Lidocaine)
Lidocaine is one of the commonly used topical anesthetics used in pain management in patients with oral mucositis. Paraquat induced oral mucositis is characterized by pain. The presence of persistent pain not only affects the patients psychologically but also decreases their incentive and the ability for oral intake. Therefore, pain control eventually encourages oral intake, thus improving nutrition and reducing further complications. The different formulations of lidocaine (sprays, solutions, gels and ointments) provide clinicians with options to choose for the most effective formulation for maximal effect; Solutions are effective when anesthetics are needed to cover a wide surface area without the risk of aspiration. Four studies showed the benefit of lidocaine in reduction of pain and severity of oral mucositis.19 20 2124 The first two studies compared lidocaine gargle as compared to bland rinses and symptomatic management, the incidence of oral mucositis and pain decreased in both trials by 23.33% and 40% respectively. 19 20. The other two studies in-cooperated lidocaine as one of the ingredients for a compounded preparation, both studies reported adequate pain management.21 24 The main adverse effects associated with lidocaine are burning and stinging on the local site of administration, loss of taste due to anesthetization of the taste buds, and suppression of gag-reflex if the posterior oropharyngeal area is anesthetized26