Topical Anesthesia for Pediatric Lacerations: A Randomized Trial of Lidocaine-Epinephrine-Tetracaine Solution Versus Gel,☆☆,,★★

Presented as a platform presentation, Ambulatory Pediatric Association Annual Meeting, Washington DC, May 1996.
https://doi.org/10.1016/S0196-0644(98)70069-1Get rights and content

Abstract

Study objective: To compare the adequacy and efficacy of anesthesia experienced with lidocaine-epinephrine-tetracaine (LET) solution versus LET gel during suturing of uncomplicated lacerations on the face or scalp in children. Methods: Two hundred children with lacerations of the face and scalp requiring suturing were enrolled in this blinded, randomized controlled trial, in the emergency department of a university-affiliated children’s hospital. After the application of anesthetic solution or gel, adequacy of anesthesia was determined before suturing. Efficacy of anesthesia during laceration repair was determined by the length of time after removal of the topical anesthetic to the first sign of discomfort that required additional anesthesia or until suture completion. Results: Adequacy of initial anesthesia was equivalent between LET solution and LET gel. There was a significant difference in efficacy of anesthesia between the LET formulations. There were more patients with complete anesthesia (85% versus 76%), fewer persons with partial anesthesia (5% versus 21%), and more persons with incomplete anesthesia (9% versus 3%) in the gel group. Conclusion: LET gel is at least as effective as LET solution and possesses theoretical advantages for topical anesthesia during suturing of uncomplicated lacerations on the face and scalp in children.[Resch K, Schilling C, Borchert BD, Klatzko M, Uden D: Topical anesthesia for pediatric lacerations: A randomized trial of lidocaine-epinephrine-tetracaine solution versus gel. Ann Emerg Med December 1998;32:693-697.]

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)

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    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

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    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 America
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    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 Consult
  • Local and Regional Anesthesia

    2008, Pediatric Emergency Medicine
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From the Emergency* and Clinical Pharmacy Departments, Children’s Hospitals and Clinics–Minneapolis, and the College of Pharmacy,§ University of Minnesota, Minneapolis, MN.

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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.

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