Use of topical lidocaine in pediatric laceration repair: a review of topical anesthetics.
OBJECTIVE
To determine whether application of topical aqueous lidocaine to a laceration attenuates the pain from the subsequent lidocaine injection in children.


METHODS
Prospective, double-blind study.


METHODS
A large, urban, tertiary care children's hospital emergency department.


METHODS
A convenience sample of 100 children, five to 16 years of age, presenting with simple lacerations over a six-month period.


METHODS
An unlabelled 3-ml solution of either 1% lidocaine or placebo (saline) was used to soak a Telfa pad (Kendall, Mansfield, MA) and then placed onto the laceration for 10 minutes. The wound was then injected with 1% lidocaine, irrigated, and sutured per standard emergency department protocol. Independent pain response was elicited from the patient and parent four times: before any intervention, after the soak, after the injection, and at the end of the procedure. Blood pressure and heart rates were recorded at the same intervals.


RESULTS
Four patients were excluded. Of the 96 remaining patients, 46 received the placebo and 50 received lidocaine. Age, sex, race, and laceration length and location were similar between groups. Physiologic parameters did not differ between groups. For all four pain ratings, the independent variables of age, sex, race, and laceration length or location did not differ between groups. Topical lidocaine was ineffective in relieving pain from the injection. When groups were combined, a significant negative correlation was noted for age versus injection pain (P = .035), with older children reporting less pain from injection than younger children.


CONCLUSIONS
For children, soaking a simple laceration with 1% lidocaine does not decrease pain from the subsequent lidocaine injection.
Stewart
G M
GM
Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit 48201-2196, USA.
Simpson
P
P
Rosenberg
N M
NM
D000293:Adolescent; D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007267:Injections / Q000009:adverse effects; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D011446:Prospective Studies; D014950:Wounds, Penetrating / Q000601:surgery*
D000779:Anesthetics, Local; D008012:Lidocaine