Topical lidocaine–epinephrine–tetracaine is effective in reducing pain during laceration repair with tissue adhesive in children
- Divisions of Paediatric Emergency Medicine and Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Correspondence to : Dr Dennis Scolnik, Division of Paediatric Emergency Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8;
Commentary on: 
Implications for practice and research
Lidocaine–epinephrine–tetracaine (LET) ameliorates pain associated with laceration repair using tissue adhesive in children.
Further research about the final outcome of the laceration repair such as wound healing is required.
Trauma, in general, and lacerations, in particular, remain among the most common reasons for the emergency department visits worldwide. Different techniques exist for closing lacerations, including sutures, staples, hair tie and adhesive glue. Adhesive glue is gaining popularity as the preferred method due to the speed and ease of the procedure.1 Although not as painful as suture insertion, adhesive glue may cause a burning and painful sensation because the adhesives cause an exothermic reaction. Local analgesia with LET is a commonly used analgesia in lacerations closed by traditional suturing but it is still not routinely used for adhesive glue closure. Harman and colleagues examined the effects of the application of LET prior to wound closure using adhesive glue.
The purpose of the study was to determine whether the application of a topical analgesia (LET) prior to minor laceration repair in children using tissue adhesive could decrease the pain experienced during the procedure. The study was a randomised, placebo controlled, blinded trial involving 221 children aged 3 months to 17 years, presenting to a tertiary paediatric emergency medicine department with lacerations suitable for closure with tissue adhesive. The children received either LET or placebo before undergoing wound closure. The primary outcome was a comparison of pain ratings with adhesive application versus the placebo using established pain scores. Secondary outcome measures were physician ratings of the difficulty of wound closure and wound haemostasis. In addition, the physicians’ prediction as to which treatment the patient had received was recorded. Descriptive statistics were used to present baseline characteristics. Pain scores were compared using two-sided Wilcoxon rank-sum tests, and the χ2 test was used for categorical comparisons. Appropriate adjustments were made for age and multiple comparisons.
Children who received LET before wound closure experienced less pain than those who received the placebo and were more likely to report having a pain-free procedure; these findings were statistically significant. Complete haemostasis of the wound was more common among patients who received LET than among those who received the placebo.
Harman and colleagues’ study focused on the use of LET to alleviate pain in the repair of lacerations with adhesive glue. Findings demonstrate the clear benefits of using LET in terms of pain reduction as well as better haemostasis during wound closure. This study confirms the value of LET preapplication, but it should be highlighted that a range of techniques lessen the pain children experience during procedures such as laceration repair. These measures include appropriately timed systemic analgesia, distraction techniques (provided by parents, medical personnel and/or play therapists) and sucrose in infants.2 As highlighted in this study, these measures increase the success of painful procedures undertaken in the emergency department.3 Optimal care involves more than just pain control; a recent study demonstrated that good physician communication was the most important factor in parents’ satisfaction during laceration repair.4 Questions which still remain unanswered regarding the use of local anaesthetics and adhesive glue include how their use affects patient flow through the emergency department and how their use affects the final outcome of the laceration repair such as wound healing.