Many parents and children are scared and anxious about the pain from pokes, or needle sticks. 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.

How much does it cost and where can I buy it?

You can get it at most pharmacies including UWHC pharmacies. The price varies by pharmacy. You can ask any UWHC Health Pharmacy about their current prices. Some pharmacies may not keep it in the store and may need a few days to order it.

Will insurance pay for it?

Some insurance plans will cover it. Call your insurance company to ask.

Common Poke Sites

If you don’t know which site will be used, call and ask the nurse. You can also wait to apply the cream until you come for your visit. Most likely places for a needle stick:

Thigh: Used for infants and children up to 5 years


Arm: Used for children 2 years of age and older.


How do I apply the cream?

  1. Put on gloves, if you have them.

  2. Rub a small amount of L.M.X.4 cream to the area the needle will go in.

  3. Rub into the skin for about 30 seconds.

  4. 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.

  5. Wrap the arm or leg loosely with a dressing or clear plastic wrap 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.

  6. Remove gloves. If you do not have gloves, rinse your hands under running water. Do not use soap or alcohol gels. This may increase the amount you absorb into your skin.


  • Do not use heat or cold on the site as this can change how much medicine is absorbed.

  • Apply the cream just before leaving for your visit. If you live more than one hour away, wait and apply the cream once you arrive for your visit.

  • 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.

  • The cream should be on the skin at least 20-30 minutes for best results.

  • The cream can remain on the skin for up to 1 hour.

  • The numbness will last for up to 90 minutes after the cream has been wiped away.
    L.M.X.4 Safety Guidelines

  • Store at room temperature. Keep it out of the reach of small children.

  • Each small tube (15 gram) contains enough medicine for 2-4 uses. Throw the tube away when it has expired.

  • Do not use on skin that has open wounds, redness or rashes.

  • Do not use L.M.X.4 on lips, mouth or diaper areas.

Side Effects

Mild side effects include:

  • Short-term blanching (whitening) of the skin where the cream was put. Later, the skin may turn red.

  • Itching at the site.

When to Call

If you notice any changes in behavior or have any concerns, remove the cream from the skin right away. Then, call your child’s doctor’s office. After hours, ask for the doctor on call.