Electronic Letters to:
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eLetters: Electronic letters published:
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Topical anaesthesia in children
- Matt Baker (14 July 2004)
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Topical Anaesthesia in Children – an alternative to cocaine
- Bimal M Mehta, A. B. Stewart, E. J. Lawson (29 June 2004)
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Matt Baker, A&E middle grade Royal Cornwall Hospital Treliske, Cornwall
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matt_g_baker{at}yahoo.co.uk Matt Baker
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Dear Editor I read kennedy et al's article regarding the use of topical cocaine and adrenaline with interest. I have also seen instillagel (2% lignocaine and 0.25% chlorhexidine)used with good effect when placed on childrens wounds to allow exploration and closure within the emergency department setting. The great advantages being that it is easily available within the department and when working out safe doses lignocaine is a familiar drug and is also the drug of choice if supplemental injections are needed. If these injections are placed through the cut edge where the gel has been applied the distress to the child is minimal. |
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Bimal M Mehta, Specialist Registrar Alder Hey Children's Hospital, Eaton Road, Liverpool, L12 2AP, A. B. Stewart, E. J. Lawson
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bimalm{at}bigfoot.com Bimal M Mehta, et al.
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Dear Editor The Emergency Department (ED) at Alder Hey Children’s Hospital, Liverpool has several years experience using topical adrenaline and cocaine gel (topAC) as an anaesthetic for suturing lacerations of head and body in children. We, therefore, read the article by Kennedy et al. with interest.[1] An audit conducted within our department showed similar results to Kennedy’s with a high degree of operator and patient/parent satisfaction. The dose of topAC used according to our protocol is based on wound length (1ml per 1cm wound up to a maximum of 3ml; minimum age 3 years). No adverse effects have occurred in the time topAC has been in use. However, we noted that topAC was not being used in the ED in all situations when it may be beneficial as there were concerns regarding toxicity and potential fatal outcome. Additionally, the cocaine component requires the gel to be handled as a controlled substance, which can cause practical difficulties. Consequently, we are currently piloting the use of an alternative topical anaesthetic. A solution containing lidocaine, epinephrine and tetracaine (LET) is in common usage in the USA and is available in the UK as a special preparation. It has been shown to be as effective as infiltrated lidocaine, topAC and tetracaine, adrenaline and cocaine gel (TAC) for anaesthetising lacerations prior to suturing.[2,3] We, our patients and their families have found the LET solution provides as effective anaesthesia for repair of lacerations of face and scalp. On the occasions when supplemental infiltrated lidocaine has been required, injection has been less painful to administer. Additional advantages are that topical anaesthetics make wound inspection and toilet more comfortable and do not cause tissue distortion, allowing for more accurate wound closure. We now plan to formally introduce LET solution into the ED and withdraw topAC. Our protocol will aim to apply LET to suitable wounds at triage thus enabling adequate assessment and repair of wounds while reducing delay in the ED. We will continue to audit and assess its use. Dr. A. B. Stewart, Consultant Paediatric Accident and Emergency Medicine References 1. Kennedy DWG, Shaikh Z, Fardy MJ, Evans RJ, Crean StJ. Topical adrenaline and cocaine gel for anaesthetising children’s lacerations. An audit of acceptability and safety. Emerg Med J 2004;21:194-196 2. Bush S. Is cocaine needed in topical anaesthesia? Emerg Med J 2002;19: 418-422 3. Brent AStG. The Management of Pain in the Emergency Department. Pediatr Clin N Am 2000; 47(3):651-679 |
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