In children with simple finger lacerations does LAT gel provide safe local anaesthesia?
- Report By: Kirsten Walthall - ST3 Emergency Medicine
- Institution: RMCH
- Date Submitted: 22nd February 2011
- Last Modified: 10th April 2013
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Status:
Blue (submitted but not checked)
Three Part Question
In [children with simple finger lacerations] does [LAT gel] provide [safe local anaesthesia]?Clinical Scenario
You’ve just seen a 6yr old little girl with a gaping laceration to the palmar aspect of her index finger. You feel it requires sutures but are unsure if LAT gel is safe to use in digits.Search Strategy
Medline 1950 to Oct 2012and EMBASE.(finger$ OR digit$ OR extremity) AND (wound$ OR laceration$ or trauma$ or injur$) AND (lidocaine OR tetracaine OR adrenaline OR epinephrine OR LAT) AND (anesthe$ OR anaesthe$ OR analgesia OR (pain AND control) OR (pain AND relief)).
Search Outcome
Altogether 75 papers were identified. Two papers seemed relevant to the question : one meta analysis and one case study.Relevant Paper(s)
| Author, date and country | Patient group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| White et al 2004 USA | 67 children aged 5 to 18 with superficial finger lacerations less than 3cm in length and less than 8 hours old. | Prospective case study. | No sign of digital ischaemia in any of the 67 children at 30mins, 60mins or at follow up 3-5 days post procedure. | Small sample size. Convenience sample. | |
| Schremmer 2004 USA | Paediatrics | Meta analysis | One study found LET [LAT] to be safe and effective for simple finger lacerations with no digital ischaemia in 63 patients |
Comment(s)
The case study of 67 patients demonstrated that none developed any sign of ischaemia when LAT gel was used on simple finger lacerations, although they suggest that a larger study is needed to fully evaluate this. Previous Bets have shown that it is safe to use adrenaline in digital ring blocks.Clinical Bottom Line
In view of the lack of evidence to suggest that topical application of local anaesthetic agents with adrenaline causes adverse effects I feel that LAT gel is safe to use in simple finger lacerations for aiding wound management.References
- White et al The Anesthetic Effectiveness of Lidocaine-Adrenaline-Tetracaine Gel on Finger Lacerations. Paediatric Emergency Care 20:812-815
- Robert D. Schremmer New Concepts in Wound Management Clinical Paediatric Emergency Medicine 5:239-245