Singer A J, Stark M J
Department of Emergency Medicine, State University of New York at Stony Brook, Stony Brook, NY 11794-7400, USA.
Acad Emerg Med. 2001 Mar;8(3):223-30. doi: 10.1111/j.1553-2712.2001.tb01297.x.
To compare the anesthetic efficacy of EMLA cream (eutectic mixture of local anesthetics) with that of LET solution (lidocaine, epinephrine, tetracaine) for pretreating lacerations prior to lidocaine injection.
This was a randomized, double-blind clinical trial in a convenience sample of 60 patients aged 1 to 59 years with traumatic lacerations. Eligible wounds were uncomplicated, clean lacerations < or = 6 hours old. Finger and toe lacerations were excluded. At the time of initial presentation to triage, patients were randomized to LET or EMLA. A nurse applied the topical anesthetic into the laceration with a 5-mL syringe. A physician assessed the laceration edges for the presence of blanching and adequacy of anesthesia to a 27-gauge needlestick. Supplemental lidocaine was then infiltrated through the wound edges and the pain of infiltration was recorded by the patient (or guardian) on a 100-mm visual analog scale marked "most pain" at the high end. A sample of 44 patients had 90% power to detect a 20-mm difference in injection pain (two-tailed alpha = 0.05).
Sixty patients were randomized to LET (29) or EMLA (31). Median age was 8.5 years; 23% were female. Most lacerations were facial and closed with sutures. There was no difference in baseline characteristics between groups. More wounds treated with LET were anesthetic to a needlestick than wounds treated with EMLA (73% vs 40%, p = 0.01); however, there was no between-group difference in the median pain of lidocaine infiltration (LET-12 mm vs EMLA-13 mm, p = 0.89).
Pretreatment of simple lacerations with LET or EMLA at the time of patient presentation results in similar amounts of pain of subsequent local infiltration of lidocaine
比较复方利多卡因乳膏（局部麻醉药的共熔混合物）与利多卡因、肾上腺素、丁卡因溶液（LET溶液）在利多卡因注射前预处理裂伤的麻醉效果。
这是一项随机双盲临床试验，选取了60例年龄在1至59岁的创伤性裂伤患者作为便利样本。符合条件的伤口为无并发症的清洁裂伤，受伤时间≤6小时。手指和脚趾裂伤被排除在外。在初次分诊时，患者被随机分为LET组或复方利多卡因乳膏组。一名护士用5毫升注射器将局部麻醉药涂于裂伤处。一名医生评估裂伤边缘是否出现苍白以及对27号针头穿刺的麻醉效果是否充分。然后通过伤口边缘注射补充利多卡因，患者（或监护人）在标记为“最痛”的100毫米视觉模拟量表上记录注射疼痛程度。44例患者的样本有90%的把握度检测到注射疼痛有20毫米的差异（双侧α=0.05）。
60例患者被随机分为LET组（29例）或复方利多卡因乳膏组（31例）。中位年龄为8.5岁；23%为女性。大多数裂伤位于面部，采用缝合闭合。两组之间的基线特征无差异。接受LET治疗的伤口对针头穿刺的麻醉效果优于接受复方利多卡因乳膏治疗的伤口（73%对40%，p=0.01）；然而，利多卡因浸润的中位疼痛在组间无差异（LET组为12毫米，复方利多卡因乳膏组为13毫米，p=0.89）。
患者就诊时用LET或复方利多卡因乳膏预处理简单裂伤，随后利多卡因局部浸润的疼痛程度相似
