LET versus EMLA for pretreating lacerations: a randomized trial.

Abstract

OBJECTIVE:

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.

METHODS:

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).

RESULTS:

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).

CONCLUSIONS:

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

• Authors: A J Singer, M J Stark
• Journal: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine (Acad Emerg Med) Vol. 8 Issue 3 Pg. 223-30 (Mar 2001) ISSN: 1069-6563 [Print] United States
• PMID: 11229943 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)

Chemical References

• Anesthetics, Local
• Lidocaine, Prilocaine Drug Combination
• Ointments
• Prilocaine
• Lidocaine

Topics

• Adolescent
• Adult
• Anesthetics, Local (therapeutic use)
• Child
• Child, Preschool
• Double-Blind Method
• Female
• Humans
• Infant
• Lacerations (therapy)
• Lidocaine (therapeutic use)
• Lidocaine, Prilocaine Drug Combination
• Linear Energy Transfer (drug effects)
• Male
• Middle Aged
• Ointments
• Pain (etiology)
• Pain Measurement
• Prilocaine (therapeutic use)
• Treatment Outcome
• Wound Healing (drug effects, radiation effects)