Topical Anesthesia for Pediatric Lacerations: A Randomized Trial of Lidocaine-Epinephrine-Tetracaine Solution Versus Gel☆,☆☆,★,★★
Section snippets
INTRODUCTION
Lacerations are a common pediatric emergency. Traditional methods of anesthesia with lidocaine infiltration were initially challenged by Pryor et al1 in 1980. They and subsequent researchers reported the use of topical tetracaine-adrenaline- cocaine (TAC) solution, which was shown to be as efficacious as subcutaneous lidocaine infiltration.1, 2 Topical anesthesia provided many benefits including reduced pain, improved patient cooperation. and decreased tissue distortion.
Since the study by Pryor
MATERIALS AND METHODS
This study was a prospective, single-blinded, randomized controlled clinical trial that enrolled a convenience sample of 200 children who presented to the ED of a university-affiliated private children’s hospital from March 1995 to March 1996. The study design and patient consent procedures were approved by the institutional review board.
Children were eligible if they had an uncomplicated laceration of the face or scalp that could be completely covered by a sterile 2×2-inch gauze square.
Participant data and follow-up
A total of 200 patients were enrolled from March 1995 through March 1996. Data sheets from 3 patients were missing and therefore could not be analyzed, leaving 197 available for analysis. One hundred five patients were randomly assigned to receive the solution and 92 patients were assigned to receive gel. Three patients were withdrawn from the study before the 27-gauge needle test for adequacy of anesthesia because of patient uncooperativeness or discovery of a complicated laceration that did
DISCUSSION
As a result of the use of topical local anesthetics, the need for painful infiltration of wounds and the use of pediatric sedation before suturing has decreased.17 The use of a topical anesthetic gel has the additional benefits of containment of anesthetic within the wound and decreased risk of run off onto mucosal and ocular surfaces.
In this prospective, randomized, single-blind trial, no difference was found between LET solution and gel with regard to adequacy of anesthesia before suturing. A
References (17)
- et al.
Local anesthesia in minor laceration: Topical TAC vs lidocaine infiltration
Ann Emerg Med
(1980) - et al.
Local anesthesia in pediatric patients: Topical TAC versus lidocaine
Ann Emerg Med
(1990) Clinical comparison of TAC anesthetic solutions with and without cocaine
Ann Emerg Med
(1985)- et al.
TAC toxicity in the emergency department
Ann Emerg Med
(1991) - et al.
Seizures following topical application of local anesthetics to burn patients
Ann Emerg Med
(1984) - et al.
Recurrent seizures following mucosal application of TAC
Ann Emerg Med
(1988) Fatality secondary to misuse of TAC solution
Ann Emerg Med
(1988)- et al.
Use of tetracaine, epinephrine, and cocaine as a topical anesthetic in the emergency department
Ann Emerg Med
(1992)
Cited by (44)
Pain-Less Practice: Techniques to Reduce Procedural Pain and Anxiety in Pediatric Acute Care
2017, Clinical Pediatric Emergency MedicineCitation Excerpt :The liquid form of LET is held in place over the wound with a cotton ball and tape, and the gel form is generally held in place with a plastic dressing (such as Tegaderm; 3M, Minneapolis, MN). Both forms of LET have been found to be equally effective.22 LET decreases needle injection pain relative to placebo and frequently can provide adequate anesthesia to obviate the need for subsequent lidocaine injection.23,24
Common office procedures and analgesia considerations
2013, Pediatric Clinics of North AmericaCitation Excerpt :Because lidocaine is hydrophilic, administration through intact skin presents a challenge. For a laceration, placing a mixture of lidocaine, tetracaine, and adrenaline (epinephrine), also known as LET or LAT (see Table 2), directly on the wound before cleaning and suturing is between 73% and 90% effective.60 Ideally, saturate a wound-sized piece of cotton and pack into the wound for 20 minutes before cleaning.
Pediatric procedural sedation and analgesia
2013, Emergency Medicine Clinics of North AmericaCitation Excerpt :This agent has been shown to be more effective for scalp and facial lacerations than for truncal and extremity lacerations. Resch and colleagues21 showed 85% complete anesthesia when repairing uncomplicated face and scalp lacerations with primary closure. LET is available as an aqueous solution or gel.
Laceration Repair
2011, Dermatologic and Cosmetic Procedures in Office Practice: Expert ConsultLocal and Regional Anesthesia
2008, Pediatric Emergency Medicine
- ☆
From the Emergency* and Clinical Pharmacy‡ Departments, Children’s Hospitals and Clinics–Minneapolis, and the College of Pharmacy,§ University of Minnesota, Minneapolis, MN.
- ☆☆
Reprints not available from the authors.
- ★
Address for correspondence: Karen Resch, MD, Emergency Medicine Department, Children’s Hospitals and Clinics–Minneapolis, 2525 Chicago Avenue South, Minneapolis, MN 55404; 612-813-6843,fax 612-813-7362.
- ★★
47/1/94232