title: Efficacy of pain control with topical lidocaine-epinephrine-tetracaine during laceration repair with tissue adhesive in children: a randomized controlled trial.
abstract: BACKGROUND
  Some children feel pain during wound closures using tissue adhesives. We sought to determine whether a topically applied analgesic solution of lidocaine-epinephrine-tetracaine would decrease pain during tissue adhesive repair.
  
  
  METHODS
  We conducted a randomized, placebo-controlled, blinded trial involving 221 children between the ages of 3 months and 17 years. Patients were enrolled between March 2011 and January 2012 when presenting to a tertiary-care pediatric emergency department with lacerations requiring closure with tissue adhesive. Patients received either lidocaine-epinephrine-tetracaine or placebo before undergoing wound closure. Our primary outcome was the pain rating of adhesive application according to the colour Visual Analogue Scale and the Faces Pain Scale--Revised. Our secondary outcomes were physician ratings of difficulty of wound closure and wound hemostasis, in addition to their prediction as to which treatment the patient had received.
  
  
  RESULTS
  Children who received the analgesic before wound closure reported less pain (median 0.5, interquartile range [IQR] 0.25-1.50) than those who received placebo (median 1.00, IQR 0.38-2.50) as rated using the colour Visual Analogue Scale (p=0.01) and Faces Pain Scale--Revised (median 0.00, IQR 0.00-2.00, for analgesic v. median 2.00, IQR 0.00-4.00, for placebo, p<0.01). Patients who received the analgesic were significantly more likely to report having or to appear to have a pain-free procedure (relative risk [RR] of pain 0.54, 95% confidence interval [CI] 0.37-0.80). Complete hemostasis of the wound was also more common among patients who received lidocaine-epinephrine-tetracaine than among those who received placebo (78.2% v. 59.3%, p=0.008).
  
  
  CONCLUSIONS
  Treating minor lacerations with lidocaine-epinephrine-tetracaine before wound closure with tissue adhesive reduced ratings of pain and increased the proportion of pain-free repairs among children aged 3 months to 17 years. This low-risk intervention may benefit children with lacerations requiring tissue adhesives instead of sutures.
  
  
  BACKGROUND
  ClinicalTrials.gov, no. PR 6138378804.
authors.forename: Stuart
authors.initials: S
authors.lastname: Harman
authors.forename: Roger
authors.initials: R
authors.lastname: Zemek
authors.forename: Mary Jean
authors.initials: MJ
authors.lastname: Duncan
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Ying
authors.forename: William
authors.initials: W
authors.lastname: Petrcich
mesh_terms: D000279:Administration, Cutaneous; D000293:Adolescent; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004338:Drug Combinations; D004636:Emergency Service, Hospital; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007223:Infant; D022125:Lacerations / Q000150:complications / Q000628:therapy; D008012:Lidocaine / Q000627:therapeutic use*; D008297:Male; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D013748:Tetracaine / Q000627:therapeutic use*; D014014:Tissue Adhesives / Q000627:therapeutic use; D016896:Treatment Outcome; D058106:Wound Closure Techniques / Q000009:adverse effects
chemical_list: D000779:Anesthetics, Local; D004338:Drug Combinations; D014014:Tissue Adhesives; D013748:Tetracaine; D008012:Lidocaine; D004837:Epinephrine
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