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Am J Emerg Med. 2007 May;25(4):379-84.

Expanding the use of topical anesthesia in wound management: sequential layered application of topical lidocaine with epinephrine.

Author information

  • 1Department of Emergency Medicine, The Cambridge Hospital, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School, Boston, MA 02139, USA. slava_gaufberg@hms.harvard.edu

Abstract

Topical anesthesia eliminates the need for injection of anesthetic. Most studies on the use of topical anesthesia were done on children, using 3 active ingredients (lidocaine, epinephrine, tetracaine, or tetracaine, adrenaline, cocaine) for relatively small wounds of the face and scalp.

OBJECTIVES:

To demonstrate that topical anesthesia is effective and safe in adults of all ages and for larger wounds, using a preparation with 2 active ingredients, topical lidocaine and epinephrine (TLE).

METHODS:

One hundred patients were enrolled in a randomized controlled trial, with 50 in each group. The study group received TLE using a unique method of "sequential layered application." The control group received 2% lidocaine infiltration anesthesia. Patients rated the pain from the application of anesthesia and from suturing, using a 0 to 10 visual analog pain scale. Follow-up interviews were conducted to assess for complications and to rate patients' wound repair experience.

RESULTS:

Patients in the study group reported significantly less pain from TLE application, with 66% reporting no pain vs 0% reporting no pain from the infiltration in the control group (P < .001). There was no difference in pain during wound repair between the 2 groups (P approximately .59). On follow-up, 95% of patients contacted in the TLE group rated their experience in regard to pain as "excellent," compared to 5% of patients in the control group (P < .001).

CONCLUSION:

Topical lidocaine and epinephrine "sequential layered application" is an effective, safe, and less painful method of anesthesia for a wide variety of lacerations. Patients recall their experience with this technique very favorably.

PMID:
17499653
[PubMed - indexed for MEDLINE]
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