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Pliaglis Cream (Pre injection Analgaesic)

Discussion in 'General Issues and Discussion Forum' started by Leah Claydon, Feb 6, 2014.

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  1. Leah Claydon

    Leah Claydon Active Member


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    Hi

    Following last month's article in Pod Now about Pliaglis Cream I thought I'd try and get my hands on some to try in clinic.

    Problem 1 was finding a supplier. Eventually, Clinidirect supplied after much to-ing and fro-ing of POMs annotation evidence and due acquisition and supply paperwork.

    Problem 2 The cost!!!! £50 a tube roughly (tiny tube, single use)

    Problem 3 Delivery & Storage - has be stored in a drug fridge at 3-8 degrees (luckily have drug fridge) and therefore had to be delivered in a refrigerated van (so don't expect the usual Pod supplies to be stocking it soon!).

    I had a PNA and 2 verruca needlings to do today so thought I'd give the stuff a go.
    It needs to be applied 30-40 minutes before injection which can be a little tricky as you need to send the patient out to sit with their foot up somewhere whilst it takes effect. You apply a 1mm thick application to the injection site and it forms a gel-sheet that peels off easily in a sheet.

    It achieved good analgaesia on the thinner skin of the hallux and the patient did not report any pain (but obviously still felt the LA stinging as the liquid was introduced).

    In Pod Now it suggested it could be useful on plantar warts. On the plantar surface only minimal analgaesia was achieved and so I would not recommend it over VPs but it could be useful to inject through if you can access the VP from the foot margins for a floatation.

    It's only my first attempt so there may be some user error here - possibly leaving the cream in situ for longer.

    My first thoughts though are that it is probably not particularly practical for use in private practice on grounds of storage, single use and cost. Could be useful for extremely needle phobic patients and charged out as a premium service.

    It'd be interesting to hear if anyone else has tried it.

    Leah
     
  2. Kaleidoscope

    Kaleidoscope Active Member

    Dear Leah

    I have tried it - although I dont like to make unsubstantiated claims so I tried it first on myself!

    Funnily enough it was not painful at all on the medial side of the hallux but I felt a little on the lateral side.... I realised it needs to be left on nearer 40 mins and that 1mm is NOT thick enough as it was 1mm on lateral side and 2mm on medial side.

    Just in case I was a strange person who didnt feel pain I injected myself on the other hallux and realised it took ALOT of pain away lol!!!!! Incidentally warming the LA in a pocket (or in my case bra) stops the added pain of cold anaesthetic into the toe.... I always do that - dont you?

    BTW It lasts 3 months NOT in fridge as long its below 25 degrees C which is pretty hot!!!!! Unopened it lasts 1 year. You could keep it in a cupboard?

    I think its uses are myriad .... like neuro-vascular corns and painful VPs? Perhaps painful involuted nails (not broken skin). As I see it, as long as the tube does NOT touch any skin but is 'dropped' onto a spatula for use on each patient it can be used again within 3 months. The amount needed for use is minimal so is actually more cost effective than you say? Mine cost £41 including postage etc.

    Regards

    Linda Russell
     
  3. Kaleidoscope

    Kaleidoscope Active Member

    BTW although it appeared in our mag - its does NOT yet have approval from the medicines committee for our use - that still needs to be confirmed. As although we are allowed to adminster lidocaine the other LA component - tetracaine is not currently on our list! I think it would be a very helpful adjunct to our clinical pharmacopoeia and would greatly improve uptake of nail surgery for those individuals who cannot bear the pain of injections.

    Linda Russell
     
  4. Leah Claydon

    Leah Claydon Active Member

     
  5. Kaleidoscope

    Kaleidoscope Active Member

    Hi Leah

    Yes you are right it lasts a year (kept in a fridge) I didnt make that very clear did I! But my point was that ONCE OPENED you can keep it in a cupboard (or anywhere basically below 25 degrees C which is virtually anywhere) which I, too, find odd.

    BTW there is another thread regarding an LA cream which we CAN use now but at 2.5% Lidocaine and 2.5% Prilocaine - I doubt whether it is as effective..... but I shall have to try it out won't I!

    Thanks for your delightful chick anecdote.

    Regards

    Linda Russell
     
  6. tonywatson12

    tonywatson12 Active Member

    hi i think its my thread on Denela 5%
    was talking over with the pharmacy guys and it seems new on the market so got some
    it is a p so patients can get it prior to attending.

    Someone told me that the best way to try something is on yourself!!! Denela is applied the usual way big blob and op-site and left on 1 - 5 hours

    results on my one foot clinical study- med sulci clearance with blacks file (my longstanding o/c problem) yer i know should have pna was good.

    I would say ask patients to leave on for 3 hours prior to treatment and after a warm foot bath.

    From what i found about 75% effective and lasted about 3 hours after clearing nail (quite extensive coz very sore after the 3 hours)

    As it is only 4-5 quid worth a try has leaflet that supports soft tissue procedure use so ok with evidence based malarkey.

    hope this is of use PLEASE let me know what you think

    Tony
     
  7. Leah Claydon

    Leah Claydon Active Member

    Hi

    Thanks for info on Danela - it sounds like a better version of Emla. Do you have to occlude it. The good thing about Pliaglis is that it forms a self-occluding gel-like sheet.

    3 hours is a long time to wait for analgaesia.

    I enjoyed the imagery of your gouging your toe with a b/file.
     
  8. tonywatson12

    tonywatson12 Active Member

    hi
    yer same routine as emla just get the patients to put on before appointment and they buy it the day before.
    worth a try

    yep the hope the sore toe sacrifice to the god of la was of some use!! :eek:
     
  9. Jose Antonio Teatino

    Jose Antonio Teatino Well-Known Member

    Unfortunately no topical anesthetic is effective on skin integration.
    Only on mucous are really helpful.
    I have experimented with EMLA, Lamdalina and others are available in pharmacies in my country.
    Not prevent the actual sensitivity of needlestick.
    Just as a placebo may be helpful.
    Anxiolytic or application of nitrous oxide mask is more effective in patients difficult.
    Recommend direct their research to offer their patients less pain when applying local anesthetics, using thinner needles 30G.
    Sincerely:
     
  10. Dr Alan Borthwick

    Dr Alan Borthwick Welcome New Poster

    Dear Linda and colleagues,

    I have been asked by colleagues to clarify the status of Pliaglis for you (in my capacity as Chair of the Medicines and Medical Devices Committee of the College of Podiatry). Following confirmation from the Medicines and Healthcare products Regulatory Agency (MHRA) today, I can confirm that podiatrists are not permitted to administer the injectable form of Pliaglis (as this is a prescription only medicine that is not listed on the administration exemptions for podiatrists). The topical form is a 'P' medicine (pharmacy only), which means that podiatrists are not permitted to sell or supply the medicine (as it is not listed on the sale or supply exemptions for podiatrists). However, podiatrists are permitted to purchase and administer the topical form of Pliaglis in the course of their professional practice.
     
  11. Leah Claydon

    Leah Claydon Active Member

    Dear Alan

    A big welcome to the forum.

    Great to see such a useful and informative post. THANK YOU.

    Leah
     
  12. Kaleidoscope

    Kaleidoscope Active Member

    Dear Dr. Alan

    I am much obliged to you for clarifying our position as regards the use of Pliaglis. Although I was surprised that it has been classified 'P' as the company I bought it from said it was a POM and would not sell it to me until they had checked I was on the HCPC Register AND had POM on my file?

    Since I did NOT intend to sell or supply Pliaglis to patients, Im glad you intervened on our behalf, as it will be a very useful adjunct to my practice, having used it on myself without any pain - unlike the useless EMLA cream.

    With kind regards


    Linda Russell
     
  13. Dr Alan Borthwick

    Dr Alan Borthwick Welcome New Poster

    Dear Linda and colleagues,

    I have re-checked the status of Pliaglis (again) with MHRA, in light of your comments, and it seems that it is tetracaine which is available as a 'P' medicine, not Pliaglis, which is indeed available only as a prescription only medicine (POM). Unfortunately this means that, as Pliaglis is not on our exemption list for administration, podiatrists are not able to access or administer the medicine. Apologies for the error on my part. I will take this issue back to the Medicines and Medical Devices Committee with a view to seeking its addition to the administration exemption list.
     
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