Gaufberg Slava V, Walta Michael J, Workman Tom P
Department of Emergency Medicine, The Cambridge Hospital, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School, Boston, MA 02139, USA.
Am J Emerg Med. 2007 May;25(4):379-84. doi: 10.1016/j.ajem.2006.11.013.
Topical anesthesia eliminates the need for injection of anesthetic. Most studies on the use of topical anesthesia were done on children, using 3 active ingredients (lidocaine, epinephrine, tetracaine, or tetracaine, adrenaline, cocaine) for relatively small wounds of the face and scalp.
To demonstrate that topical anesthesia is effective and safe in adults of all ages and for larger wounds, using a preparation with 2 active ingredients, topical lidocaine and epinephrine (TLE).
One hundred patients were enrolled in a randomized controlled trial, with 50 in each group. The study group received TLE using a unique method of "sequential layered application." The control group received 2% lidocaine infiltration anesthesia. Patients rated the pain from the application of anesthesia and from suturing, using a 0 to 10 visual analog pain scale. Follow-up interviews were conducted to assess for complications and to rate patients' wound repair experience.
Patients in the study group reported significantly less pain from TLE application, with 66% reporting no pain vs 0% reporting no pain from the infiltration in the control group (P < .001). There was no difference in pain during wound repair between the 2 groups (P approximately .59). On follow-up, 95% of patients contacted in the TLE group rated their experience in regard to pain as "excellent," compared to 5% of patients in the control group (P < .001).
Topical lidocaine and epinephrine "sequential layered application" is an effective, safe, and less painful method of anesthesia for a wide variety of lacerations. Patients recall their experience with this technique very favorably.
局部麻醉无需注射麻醉剂。大多数关于局部麻醉使用的研究是针对儿童进行的，使用三种活性成分（利多卡因、肾上腺素、丁卡因或丁卡因、肾上腺素、可卡因）用于面部和头皮相对较小的伤口。
使用含有两种活性成分的局部利多卡因和肾上腺素制剂（TLE），证明局部麻醉在各年龄段成年人及较大伤口中是有效且安全的。
100名患者参加了一项随机对照试验，每组50人。研究组采用独特的“序贯分层应用”方法接受TLE。对照组接受2%利多卡因浸润麻醉。患者使用0至10的视觉模拟疼痛量表对麻醉应用和缝合时的疼痛进行评分。进行随访访谈以评估并发症并对患者的伤口修复体验进行评分。
研究组患者报告TLE应用引起的疼痛明显减轻，66%报告无疼痛，而对照组浸润麻醉无疼痛报告的为0%（P < 0.001）。两组伤口修复时的疼痛无差异（P约为0.59）。随访时，TLE组95%接受联系的患者将其疼痛体验评为“优秀”，而对照组为5%（P < 0.001）。
局部利多卡因和肾上腺素“序贯分层应用”是一种有效、安全且疼痛较轻的麻醉方法，适用于多种撕裂伤。患者对这种技术的体验评价很高。
