From the Pediatric Emergency Medicine Faculty, Children's Hospital of Orange County, Orange.
David Geffen School of Medicine, University of California, Los Angeles, Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA.
Pediatr Emerg Care. 2022 Feb 1;38(2):e472-e474. doi: 10.1097/PEC.0000000000002631.
Lidocaine (4%), epinephrine (0.1%), and tetracaine (0.5%) topical gel (LET) is a safe and effective method of providing anesthesia for laceration repair. Some patients, however, require additional infiltrated local anesthetic. We sought to determine if 3 applications of LET 10 minutes apart (triple LET) result in lower pain scores with suturing than one application for 30 minutes (single LET).
We performed a randomized single-blind controlled trial of pediatric emergency department patients 7 to 17 years old with simple lacerations requiring sutures. Patients received either triple or single LET, and the first suture was placed or attempted within 15 minutes of removing the LET. Visual analog pain score on a 100-mm scale was obtained by a blinded nurse. Pain scores between groups were compared using the Wilcoxon rank sum test.
Forty-eight patients were enrolled: 21 for single LET and 27 for triple LET. Mean visual analog pain scale (VAS) score for single LET patients was 16 (SD, 17; range, 0-48), and that for triple LET patients was 16 (SD, 24; range, 0-95), with the difference not significant at 0.37 (95% confidence interval, -11.9 to 12.6). There was no significant difference in requirement for additional anesthesia between single LET (4 of 21 [19%]) and triple LET (5 of 27 [19%]) patients.
Lidocaine (4%), epinephrine (0.1%), and tetracaine (0.5%) topical gel every 10 minutes for 3 applications was not superior in anesthetic efficacy to applying it once for 30 minutes.
利多卡因（4%）、肾上腺素（0.1%）和四卡因（0.5%）局部凝胶（LET）是一种安全有效的麻醉方法，可用于裂伤修复。然而，一些患者需要额外的局部浸润麻醉。我们试图确定 10 分钟给予 3 次 LET（三重 LET）与 30 分钟给予 1 次（单次 LET）相比，在缝合时疼痛评分是否更低。
我们对 7 至 17 岁需要缝合的简单裂伤的儿科急诊科患者进行了随机单盲对照试验。患者接受三重 LET 或单次 LET，去除 LET 后 15 分钟内放置或尝试第一针缝线。由盲法护士使用 100mm 刻度的视觉模拟疼痛评分（VAS）获得疼痛评分。使用 Wilcoxon 秩和检验比较组间疼痛评分。
共纳入 48 例患者：21 例接受单次 LET，27 例接受三重 LET。单次 LET 患者的平均视觉模拟疼痛量表（VAS）评分为 16（SD，17；范围，0-48），三重 LET 患者为 16（SD，24；范围，0-95），差异无统计学意义（0.37，95%置信区间，-11.9 至 12.6）。在额外麻醉需求方面，单次 LET（21 例中的 4 例[19%]）和三重 LET（27 例中的 5 例[19%]）患者之间无显著差异。
利多卡因（4%）、肾上腺素（0.1%）和四卡因（0.5%）局部凝胶每 10 分钟应用 3 次在麻醉效果上并不优于单次应用 30 分钟。
