Chale Stuart, Singer Adam J, Marchini Scott, McBride Mary Jo, Kennedy David
Department of Emergency Medicine, University Hospital and Medical Center, HSC L3-058, Stony Brook, NY 11794-8500, USA.
Acad Emerg Med. 2006 Oct;13(10):1046-50. doi: 10.1197/j.aem.2006.06.048. Epub 2006 Sep 13.
To compare the pain of needle insertion, anesthesia, and suturing in finger lacerations after local anesthesia with prior topical anesthesia with that experienced after digital anesthesia.
This was a randomized controlled trial in a university-based emergency department (ED), with an annual census of 75,000 patient visits. ED patients aged > or = 8 years with finger lacerations were enrolled. After standard wound preparation and 15-minute topical application of lidocaine-epinephrine-tetracaine (LET) in all wounds, lacerations were randomized to anesthesia with either local or digital infiltration of 1% lidocaine. Pain of needle insertion, anesthetic infiltration, and suturing were recorded on a validated 100-mm visual analog scale (VAS) from 0 (none) to 100 (worst); also recorded were percentage of wounds requiring rescue anesthesia; time until anesthesia; percentage of wounds with infection or numbness at day 7. Outcomes were compared by using Mann-Whitney U and chi-square tests. A sample of 52 patients had 80% power to detect a 15-mm difference in pain scores.
Fifty-five patients were randomized to digital (n = 28) or local (n = 27) anesthesia. Mean age (+/-SD) was 38.1 (+/-16.8) years, 29% were female. Mean (+/-SD) laceration length and width were 1.7 (+/-0.7) cm and 2.0 (+/-1.0) mm, respectively. Groups were similar in baseline patient and wound characteristics. There were no between-group differences in pain of needle insertion (mean difference, 1.3 mm; 95% confidence interval [CI] = -17.0 to 14.3 mm); anesthetic infiltration (mean difference, 2.3 mm; 95% CI = -19.7 to 4.4 mm), or suturing (mean difference, 7.6 mm; 95% CI = -3.3 to 21.1 mm). Only one patient in the digital anesthesia group required rescue anesthesia. There were no wound infections or persistent numbness in either group.
Digital and local anesthesia of finger lacerations with prior application of LET to all wounds results in similar pain of needle insertion, anesthetic infiltration, and pain of suturing.
比较在所有伤口均预先进行局部表面麻醉后，手指裂伤局部麻醉与指神经阻滞麻醉时的进针疼痛、麻醉过程及缝合疼痛。
这是一项在一所大学急诊科进行的随机对照试验，该急诊科年就诊量为75000人次。纳入年龄≥8岁的手指裂伤急诊患者。在对所有伤口进行标准伤口处理并局部应用利多卡因 - 肾上腺素 - 丁卡因（LET）15分钟后，将裂伤随机分为接受1%利多卡因局部浸润麻醉或指神经阻滞麻醉。采用经过验证的100毫米视觉模拟量表（VAS）记录进针疼痛、麻醉浸润及缝合疼痛，范围从0（无疼痛）至100（最剧烈疼痛）；同时记录需要追加麻醉的伤口百分比、麻醉起效时间、第7天时伤口感染或麻木的百分比。采用Mann - Whitney U检验和卡方检验比较结果。52例患者的样本量有80%的把握度检测出疼痛评分有15毫米的差异。
55例患者被随机分为指神经阻滞麻醉组（n = 28）和局部浸润麻醉组（n = 27）。平均年龄（±标准差）为38.1（±16.8）岁，29%为女性。平均（±标准差）裂伤长度和宽度分别为1.7（±0.7）厘米和2.0（±1.0）毫米。两组患者的基线特征和伤口特征相似。进针疼痛（平均差异1.3毫米；95%置信区间[CI] = -17.0至14.3毫米）、麻醉浸润（平均差异2.3毫米；95%CI = -19.7至4.4毫米）或缝合疼痛（平均差异7.6毫米；95%CI = -3.3至21.1毫米）在两组间均无差异。指神经阻滞麻醉组仅有1例患者需要追加麻醉。两组均无伤口感染或持续性麻木。
在所有伤口均预先应用LET的情况下，手指裂伤的指神经阻滞麻醉和局部浸润麻醉在进针疼痛、麻醉浸润及缝合疼痛方面相似。
