LIDOCAINE VERSUS DIPHENHYDRAMINE FOR ANESTHESIA IN THE REPAIR OF MINOR LACERATIONS

This prospective study compared the effectiveness of 1 % diphenhydrami ne with 1 % lidocaine for local anesthesia in repair of minor skin lac erations in adults with simple linear lacerations treated at our Emerg ency Department. Wounds were anesthetized with either lidocaine or dip henhydramine according to a random numbers table. Ninety-nine patients were included in the final analysis (51 received lidocaine; 48 diphen hydramine). Patients and physicians rated the pain of injection and su turing using a standard visual analog scale. Univariate and multivaria te linear models were used on rank transformed scores of the patient a nd physician ratings of injection and suturing with p < 0.05 considere d statistically significant. According to patient rating lidocaine was less painful for injection than diphenhydramine, with a statistically significant difference between the two anesthetics (p = 0.0017). Ther e was no statistically significant difference in pain rating by physic ians between the two anesthetics (p > 0.05). Pain with suturing was ra ted as minimal for both lidocaine and diphenhydramine with no statisti cally significant difference in the effectiveness according to either patients or physicians (p > 0.05). Lidocaine injection appears to hurt less than diphenhydramine injection according to the patients. Pain o f suturing corresponding to anesthetic effectiveness appears to be equ ivalent tor lidocaine and diphenhydramine according to both physicians and patients. Although diphenhydramine should not be substituted for lidocaine, it appears to be a viable alternative in the management of patients with allergy to amides or extremely large lacerations in whic h a maximum of amide anesthetic has been used.