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Three Part Question

In [children presenting with facial lacerations] can [topical LAT gel] avoid [a general anaesthetic for repair].

Clinical Scenario

A 5 year old child presents to the paediatric emergency department with a linear laceration to his forehead. There are no concerns regarding a head injury. The wound is linear, full skin thickness and occurred within the last 8 hours. You suspect that the child will require sutures to close the wound however his parents are very anxious about him requiring a “needle” whilst he is awake. You wonder if a topical anaesthetic gel could be used to allow closure and therefore prevent the need for him to return at a later date for a general anaesthetic.

Search Strategy

MEDLINE (1950 to May 2010, week 1) and EMBASE (1980 to May 2010) using the NHS national library for health interface. [LAT gel OR Lidocaine adrenaline tetracaine gel OR Lignocaine adrenaline tetracaine gel OR Lidocaine epinephrine tetracaine gel) AND (paediatric OR children) AND (facial wounds OR facial lacerations)]
The Cochrane Library was also searched (accessed May 2009) for articles on LAT gel and facial lacerations. One study was obtained that was not relevant to the specific question, focusing on comparison of different preparations of topical anaesthetics.

Search Outcome

Studies which focused on comparison of outcomes of LAT and TAC gel preparations were excluded. No studies were found on the databases which were relevant to all three parts of the question. One review was found on the EMBASE/ MEDLINE database relevant to LAT gel and facial lacerations in children. The studies included compared the use of LAT to other topical anaesthetic gel and therefore was not directly relevant.

Comment(s)

Currently there is no evidence to answer whether LAT gel could be used to reduce paediatric admissions under plastic or maxillary facial teams for general anaesthesia. Previous studies beyond the scope of this clinical question have suggested that LAT gel can be used to provide adequate analgesia in children for facial and scalp lacerations but no studies compare the use of LAT gel in children that may have traditionally been admitted for anaesthetic without any trial of repair in the department and therefore at present local policy should be followed.

Clinical Bottom Line

No evidence to suggest that the use of LAT gel in children with facial lacerations can reduce the need for admission for repair under a general anaesthetic. Further prospective trials are required.