Statistics from Altmetric.com
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.
Medic 1 Trust Fellowship
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.
The Fellowship is awarded to a doctor or nurse currently working in the field of accident and emergency medicine.
Applicants must give details of completed preparatory work and a planned itinerary. Unsupported proposals of a general nature will not be accepted. Applicants must provide the names of two referees.
The value of the award will be a maximum of £2500. The amount of the award will be made on the recommendation of the honorary treasurer and with the approval of the Medic 1 Trustees.
The recipient is to be named the Medic 1 Trust Fellow.
The recipient will be required to present a written report to the chairman of the Medic 1 Trust within three months of completion of their visit.
No individual may be awarded the Medic 1 Trust Travelling Scholarship on more than one occasion.
Applications can be made to:
The chairman of the Medic 1 Trust, c/o Maclay Murray & Spens Solicitors, 151 St Vincent Street, Glasgow G2 5NJ
A maximum of one medical scholarship and one nursing scholarship will be made every year.
Applications must be received by 31 October in any year.
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.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.