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LAT gel for laceration repair in the emergency department: not only for children?

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Objective

LAT (lidocaine, adrenaline, and tetracaine) gel is a topical anesthetic that can be applied on lacerations before suturing. It is considered easy to use and less painful than infiltrative anesthesia. Its use in laceration management has been studied the most in younger children.

We aimed to describe the potential value of the use of LAT gel in older children and adults with simple lacerations.

Materials and methods

As part of a quality audit project, we reviewed all emergency department records of patients who had LAT gel applied for laceration repair in a 3-month period following the initial protocol implementation. Patients younger than 8 years of age, under the influence of alcohol or drugs, or those who received additional sedation were excluded. The need for additional anesthesia after needle probing was used as the primary endpoint.

Results

Of the 89 patients included, 21 (23.6%) needed additional anesthesia. The length of the wound was significantly longer in the group who needed additional anesthesia (difference between medians 1 cm; 95% confidence interval 0.5–2; P<0.005). Lacerations located on the extremities/trunk/fingers/toes needed significantly more additional anesthesia compared with lacerations located on the head (19.1% difference between proportions; 95% confidence interval 1–34.8%; P<0.05).

Conclusion

LAT gel is a valuable alternative to infiltrative anesthesia for laceration repair. Its use should not be limited to children. The application of LAT gel seems to be specifically suitable for short lacerations (<4 cm), lacerations located on the head, and simple finger lacerations.
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Keywords: LAT gel; laceration; local anesthesia; topical anesthesia; trauma; wounds

Document Type: Research Article

Affiliations: 1: Faculty of Medicine and Health Sciences, Ghent University 2: Department of Emergency Medicine

Publication date: February 1, 2017

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