title: Expanding the use of topical anesthesia in wound management: sequential layered application of topical lidocaine with epinephrine.
abstract: Topical anesthesia eliminates the need for injection of anesthetic. Most studies on the use of topical anesthesia were done on children, using 3 active ingredients (lidocaine, epinephrine, tetracaine, or tetracaine, adrenaline, cocaine) for relatively small wounds of the face and scalp.
  
  
  OBJECTIVE
  To demonstrate that topical anesthesia is effective and safe in adults of all ages and for larger wounds, using a preparation with 2 active ingredients, topical lidocaine and epinephrine (TLE).
  
  
  METHODS
  One hundred patients were enrolled in a randomized controlled trial, with 50 in each group. The study group received TLE using a unique method of "sequential layered application." The control group received 2% lidocaine infiltration anesthesia. Patients rated the pain from the application of anesthesia and from suturing, using a 0 to 10 visual analog pain scale. Follow-up interviews were conducted to assess for complications and to rate patients' wound repair experience.
  
  
  RESULTS
  Patients in the study group reported significantly less pain from TLE application, with 66% reporting no pain vs 0% reporting no pain from the infiltration in the control group (P < .001). There was no difference in pain during wound repair between the 2 groups (P approximately .59). On follow-up, 95% of patients contacted in the TLE group rated their experience in regard to pain as "excellent," compared to 5% of patients in the control group (P < .001).
  
  
  CONCLUSIONS
  Topical lidocaine and epinephrine "sequential layered application" is an effective, safe, and less painful method of anesthesia for a wide variety of lacerations. Patients recall their experience with this technique very favorably.
authors.affiliation: Department of Emergency Medicine, The Cambridge Hospital, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School, Boston, MA 02139, USA. slava_gaufberg@hms.harvard.edu
authors.forename: Slava V
authors.initials: SV
authors.lastname: Gaufberg
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Walta
authors.forename: Tom P
authors.initials: TP
authors.lastname: Workman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000772:Anesthesia, Local / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D004837:Epinephrine / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D022125:Lacerations / Q000150:complications / Q000601:surgery*; D008012:Lidocaine / Q000008:administration & dosage*; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D010147:Pain Measurement; D017060:Patient Satisfaction; D011446:Prospective Studies; D013536:Suture Techniques / Q000009:adverse effects*; D013566:Sympathomimetics / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D004338:Drug Combinations; D013566:Sympathomimetics; D008012:Lidocaine; D004837:Epinephrine