title: Application of topical local anesthetic at triage reduces treatment time for children with lacerations: a randomized controlled trial.
abstract: OBJECTIVE
  We determine whether application of topical local anesthetic at triage reduces total treatment time for children with simple lacerations.
  
  
  METHODS
  This prospective, randomized, double-blind, controlled trial was conducted in an urban pediatric emergency department (ED). Participants were children who were aged 1 to 10 years and had simple lacerations. Exclusions were wounds to digits, ears, penis, nose, or mucous membranes; wounds close to the eye; deep wounds involving bone, cartilage, tendon, or vessels; wounds older than 6 hours; allergy or previous reaction to local anesthetics; trivial wounds unlikely to require any intervention; previous anesthesia to area before presentation; and failure to obtain consent. Participants were randomized to application of adrenaline 1:1,000, lignocaine (lidocaine) 4%, and amethocaine 0.5% (ALA) or placebo (adrenaline 1:1,000 solution) at triage. The primary outcome measure was total treatment time (triage time to discharge time). Secondary outcomes were the proportion of children from each group who required sedation and subgroup analysis by mode of wound closure. Analysis was by Mann-Whitney U test comparing times and chi(2) test comparing sedation rate.
  
  
  RESULTS
  One hundred sixty-one patients were eligible for analysis (84 ALA, 77 control). Sixty-five patients were sutured, 84 were treated with glue, 6 were treated with Steristrips, and 6 were not provided with formal closure. The median treatment time for the ALA group was 77 minutes compared with 108 minutes for the control group (effect size 31 minutes; 95% confidence interval 15 to 47 minutes; P =.0019). There was no difference in requirement for sedation between the groups.
  
  
  CONCLUSIONS
  The application of ALA at triage significantly reduces total treatment time for children with simple lacerations.
authors.affiliation: Department of Emergency Medicine, Sunshine Hospital, 176 Furlong Road, St. Albans 3021, Melbourne, Victoria, Australia. stephen.priestley@wh.org.au
authors.forename: Stephen
authors.initials: S
authors.lastname: Priestley
authors.forename: Anne-Maree
authors.initials: AM
authors.lastname: Kelly
authors.forename: Linda
authors.initials: L
authors.lastname: Chow
authors.forename: Colin
authors.initials: C
authors.lastname: Powell
authors.forename: Anne
authors.initials: A
authors.lastname: Williams
mesh_terms: D000772:Anesthesia, Local; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D004837:Epinephrine; D006801:Humans; D007223:Infant; D022125:Lacerations / Q000601:surgery*; D008012:Lidocaine; D011446:Prospective Studies; D013748:Tetracaine; D013997:Time Factors
chemical_list: D013748:Tetracaine; D008012:Lidocaine; D004837:Epinephrine