Use of topical lidocaine in pediatric laceration repair: A review of topical anesthetics

Objective: To determine whether application of topical aqueous lidocaine to a laceration attenuates the pain from the subsequent lidocaine injection i n children. Design: Prospective, double-blind study, Setting: A large, urban, tertiary care children's hospital emergency depart ment, Patients: A convenience sample of 100 children, five to 16 gears of age, pr esenting with simple lacerations over a six-month period. Interventions: An unlabelled 3-ml solution of either 1% lidocaine or placeb o (saline) was used to soak a Telfa(R) pad (Kendall, Mansfield, MA) and the n placed onto the laceration for 10 minutes. The wound was then injected wi th 1% lidocaine, irrigated, and sutured per standard emergency department p rotocol. Independent pain response was elicited from the patient and parent four times: before any intervention, after the soak, after the injection, and at the end of the procedure. Blood pressure and heart rates were record ed at the same intervals. Results: Four patients were excluded. Of the 96 remaining patients, 46 rece ived the placebo and 50 received lidocaine, Age, sex, race, and laceration length and location were similar between groups. Physiologic parameters did not differ between groups. For all four pain ratings, the independent vari ables of age, sex, race, and laceration length or location did not differ b etween groups. Topical lidocaine was ineffective in relieving pain from the injection. When groups were combined, a significant negative correlation w as noted for age versus injection pain (P = .035), with older children repo rting less pain from injection than younger children. Conclusion: For children, soaking a simple laceration with 1% lidocaine doe s not decrease pain from the subsequent lidocaine injection.