title: Digital versus local anesthesia for finger lacerations: a randomized controlled trial.
abstract: OBJECTIVE
  To compare the pain of needle insertion, anesthesia, and suturing in finger lacerations after local anesthesia with prior topical anesthesia with that experienced after digital anesthesia.
  
  
  METHODS
  This was a randomized controlled trial in a university-based emergency department (ED), with an annual census of 75,000 patient visits. ED patients aged > or = 8 years with finger lacerations were enrolled. After standard wound preparation and 15-minute topical application of lidocaine-epinephrine-tetracaine (LET) in all wounds, lacerations were randomized to anesthesia with either local or digital infiltration of 1% lidocaine. Pain of needle insertion, anesthetic infiltration, and suturing were recorded on a validated 100-mm visual analog scale (VAS) from 0 (none) to 100 (worst); also recorded were percentage of wounds requiring rescue anesthesia; time until anesthesia; percentage of wounds with infection or numbness at day 7. Outcomes were compared by using Mann-Whitney U and chi-square tests. A sample of 52 patients had 80% power to detect a 15-mm difference in pain scores.
  
  
  RESULTS
  Fifty-five patients were randomized to digital (n = 28) or local (n = 27) anesthesia. Mean age (+/-SD) was 38.1 (+/-16.8) years, 29% were female. Mean (+/-SD) laceration length and width were 1.7 (+/-0.7) cm and 2.0 (+/-1.0) mm, respectively. Groups were similar in baseline patient and wound characteristics. There were no between-group differences in pain of needle insertion (mean difference, 1.3 mm; 95% confidence interval [CI] = -17.0 to 14.3 mm); anesthetic infiltration (mean difference, 2.3 mm; 95% CI = -19.7 to 4.4 mm), or suturing (mean difference, 7.6 mm; 95% CI = -3.3 to 21.1 mm). Only one patient in the digital anesthesia group required rescue anesthesia. There were no wound infections or persistent numbness in either group.
  
  
  CONCLUSIONS
  Digital and local anesthesia of finger lacerations with prior application of LET to all wounds results in similar pain of needle insertion, anesthetic infiltration, and pain of suturing.
authors.affiliation: Department of Emergency Medicine, University Hospital and Medical Center, HSC L3-058, Stony Brook, NY 11794-8500, USA.
authors.forename: Stuart
authors.initials: S
authors.lastname: Chale
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Singer
authors.forename: Scott
authors.initials: S
authors.lastname: Marchini
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: McBride
authors.forename: David
authors.initials: D
authors.lastname: Kennedy
mesh_terms: D000293:Adolescent; D000328:Adult; D000700:Analgesics / Q000008:administration & dosage*; D000772:Anesthesia, Local / Q000379:methods*; D002648:Child; D004635:Emergency Medicine; D005260:Female; D005383:Finger Injuries; D006801:Humans; D008297:Male
chemical_list: D000700:Analgesics