Topical anaesthesia in children: reducing the need for specialty referral.
OBJECTIVE
The management of wounds in children is stressful, not only for the child, but also for parents and staff. In our Emergency Department (ED), we currently do not have a paediatric sedation policy, and thus children requiring suturing, not amenable to distraction and infiltrative anaesthesia, are referred to specialty teams for general anaesthesia. We proposed that the introduction of a topical anaesthetic gel (lidocaine, adrenaline, tetracaine - LAT) might help to reduce the number of referrals, by allowing the ED staff to perform the procedures, in combination with nonpharmacological approaches.


METHODS
We carried out a retrospective review of ED records of all children aged 14 years or less attending with wounds, over an 8-month period, from 01 May 2007 to 31 January 2008.


RESULTS
Two hundred and one (50.6%) patients presented before the introduction of LAT gel, whereas 196 (49.3%) patients presented afterwards. A total of 39 (19.4%) patients were referred for specialty review pre-LAT, whereas only 19 (9.7%) patients were referred in the LAT group. Of these, 31 (15.4%) pre-LAT and 15 (7.7%) LAT group required general anaesthesia. There is a significant difference between these two groups, using Fischer's exact test, P=0.018.


CONCLUSIONS
We have found that the introduction of topical anaesthetic gel in ED has significantly reduced the number of children with wounds referred to specialty teams for general anaesthesia. This has important implications for patient safety and hospital resources.
O'Connor
Gabrielle
G
Emergency Department, Mid-Western Regional Hospital, Limerick, Dublin, Ireland. gabbyoco@yahoo.com
Mullarkey
Caitriona
C
D000287:Administration, Topical; D000772:Anesthesia, Local; D000779:Anesthetics, Local; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D020793:Gatekeeping / Q000458:organization & administration*; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008511:Medicine / Q000458:organization & administration*; D010146:Pain / Q000188:drug therapy*; D010372:Pediatrics; D012189:Retrospective Studies; D013566:Sympathomimetics / Q000008:administration & dosage / Q000627:therapeutic use; D014947:Wounds and Injuries / Q000188:drug therapy*
D000779:Anesthetics, Local; D013566:Sympathomimetics; D008012:Lidocaine; D004837:Epinephrine