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Topical anaesthesia use in the management of children's lacerations, a postal survey
  1. Stephen Bush
  1. Specialist Registrar in Accident and Emergency, Accident and Emergency Department, St James's University Hospital, Leeds LS9 7TF

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    Editor,—The suturing of lacerations of children is often difficult. Infiltration with 1% plain lignocaine (lidocaine) is commonly used to make the suturing more comfortable. This infiltration may cause pain and render the child uncooperative for the rest of the procedure.

    Topical anaesthesia (TA) has been described since 1980.1 The agent commonly used is a mixture of 0.5% tetracaine, 0.05% adrenaline (epinephrine) and 11.8% cocaine (TAC). This method has a similar efficacy to infiltration but is less painful to apply2, 3 and is used widely in the United States.

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    The Medic 1 Trust Fellowship is awarded to facilitate education or research in the field of accident and emergency medicine and may be used for associated travel.

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    All 597 accident and emergency (A&E) departments in the UK were sent a questionnaire about their use of TA in children's lacerations.

    There was a 71% response rate.

    Of the 34% of all responders who used TA, 33% used Emla, 31% used lignocaine and 26% used Ametop. Less than half of these felt TA was preferable to injection. Only 8% used a cocaine and adrenaline mixture but 91% of those preferred it. TAC was used in 3%.

    Most (66%) departments did not use TA. There were many reasons given. The commonest reasons were “no experience” (28%), “TA ineffective” (20%), “slow onset” (10%) and “department protocol” (10%). Three per cent of responders were concerned about absorption.

    This survey has shown that only a minority of UK A&E departments use TA for suturing children's lacerations and, of these, few use agents for which there is evidence. TAC use has been associated with prolonged fitting4 and mortality,5 is expensive and contains a controlled drug. The rare catastrophes together with the inconvenience of its use may be why UK clinicians prefer the safer and convenient lignocaine infiltration. If an agent without cocaine was shown to have similar efficacy to TAC, it may allow more widespread use of TA in the UK.

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