In children with simple finger lacerations does LAT gel provide safe local anaesthesia?
Date First Published:
February 22, 2011
Last Updated:
April 10, 2013
Report by:
Kirsten Walthall, ST3 Emergency Medicine (RMCH)
Three-Part Question:
In [children with simple finger lacerations] does [LAT gel] provide [safe local anaesthesia]?
Clinical Scenario:
You’ve just seen a 6yr old little girl with a gaping laceration to the palmar aspect of her index finger. You feel it requires sutures but are unsure if LAT gel is safe to use in digits.
Search Strategy:
Medline 1950 to Oct 2012and EMBASE.
(finger$ OR digit$ OR extremity) AND (wound$ OR laceration$ or trauma$ or injur$) AND (lidocaine OR tetracaine OR adrenaline OR epinephrine OR LAT) AND (anesthe$ OR anaesthe$ OR analgesia OR (pain AND control) OR (pain AND relief)).
(finger$ OR digit$ OR extremity) AND (wound$ OR laceration$ or trauma$ or injur$) AND (lidocaine OR tetracaine OR adrenaline OR epinephrine OR LAT) AND (anesthe$ OR anaesthe$ OR analgesia OR (pain AND control) OR (pain AND relief)).
Outcome:
Altogether 75 papers were identified. Two papers seemed relevant to the question : one meta analysis and one case study.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| The Anesthetic Effectiveness of Lidocaine-Adrenaline-Tetracaine Gel on Finger Lacerations. White et al 2004 USA | 67 children aged 5 to 18 with superficial finger lacerations less than 3cm in length and less than 8 hours old. | Prospective case study. | No sign of digital ischaemia in any of the 67 children at 30mins, 60mins or at follow up 3-5 days post procedure. | Small sample size. Convenience sample. |
|
| New Concepts in Wound Management Robert D. Schremmer 2004 USA | Paediatrics | Meta analysis | One study found LET [LAT] to be safe and effective for simple finger lacerations with no digital ischaemia in 63 patients |
Author Commentary:
The case study of 67 patients demonstrated that none developed any sign of ischaemia when LAT gel was used on simple finger lacerations, although they suggest that a larger study is needed to fully evaluate this. Previous Bets have shown that it is safe to use adrenaline in digital ring blocks.
Bottom Line:
In view of the lack of evidence to suggest that topical application of local anaesthetic agents with adrenaline causes adverse effects I feel that LAT gel is safe to use in simple finger lacerations for aiding wound management.
References:
- White et al. The Anesthetic Effectiveness of Lidocaine-Adrenaline-Tetracaine Gel on Finger Lacerations.
- Robert D. Schremmer. New Concepts in Wound Management