title: LAT gel for laceration repair in the emergency department: not only for children?
abstract: OBJECTIVE
  LAT (lidocaine, adrenaline, and tetracaine) gel is a topical anesthetic that can be applied on lacerations before suturing. It is considered easy to use and less painful than infiltrative anesthesia. Its use in laceration management has been studied the most in younger children.We aimed to describe the potential value of the use of LAT gel in older children and adults with simple lacerations.
  
  
  METHODS
  As part of a quality audit project, we reviewed all emergency department records of patients who had LAT gel applied for laceration repair in a 3-month period following the initial protocol implementation. Patients younger than 8 years of age, under the influence of alcohol or drugs, or those who received additional sedation were excluded. The need for additional anesthesia after needle probing was used as the primary endpoint.
  
  
  RESULTS
  Of the 89 patients included, 21 (23.6%) needed additional anesthesia. The length of the wound was significantly longer in the group who needed additional anesthesia (difference between medians 1 cm; 95% confidence interval 0.5-2; P<0.005). Lacerations located on the extremities/trunk/fingers/toes needed significantly more additional anesthesia compared with lacerations located on the head (19.1% difference between proportions; 95% confidence interval 1-34.8%; P<0.05).
  
  
  CONCLUSIONS
  LAT gel is a valuable alternative to infiltrative anesthesia for laceration repair. Its use should not be limited to children. The application of LAT gel seems to be specifically suitable for short lacerations (<4 cm), lacerations located on the head, and simple finger lacerations.
authors.affiliation: aFaculty of Medicine and Health Sciences, Ghent University bDepartment of Emergency Medicine cDepartment of Pharmacy, Ghent University Hospital, Ghent, Belgium.
authors.forename: Emily
authors.initials: E
authors.lastname: Vandamme
authors.forename: Sabine
authors.initials: S
authors.lastname: Lemoyne
authors.forename: Anne
authors.initials: A
authors.lastname: van der Gucht
authors.forename: Pieter
authors.initials: P
authors.lastname: de Cock
authors.forename: Patrick
authors.initials: P
authors.lastname: van de Voorde
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D004636:Emergency Service, Hospital; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005782:Gels / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D022125:Lacerations / Q000188:drug therapy*; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013752:Tetracycline / Q000008:administration & dosage / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D005782:Gels; D008012:Lidocaine; D013752:Tetracycline; D004837:Epinephrine