Use of LAT Gel in paediatric lacerations in the Emergency Department

• Summary
• Aims
• Background
• Treatment / Management

Summary of Guideline

This guideline describes the use of Lidocaine-Adrenaline-Tetracaine gel for the local anaesthesia of paediatric lacerations.

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Aims

To improve the management of paediatric lacerations by reducing pain and distress.

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Background

The adequate anaesthesia of wounds in children is vital to ensure that they might be cleaned, explored and closed satisfactorily.
The infiltration of lacerations with lidocaine anaesthetic may be appropriate in older children and is often tolerated well, especially if Entonox is used during the infiltration.
In younger children it is easier and less distressing for the child and parents to apply a local anaesthetic mixture. This can be “topped up” with infiltrated lidocaine if required.

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Treatment / Management

Indications:

• Children 1 year of age and older
• Laceration that is likely to require suturing in the ED: length/ size irrelevant
• Deep and stellate wounds
• Wounds under tension or over joints
• Wounds requiring exploration, cleaning or debridement
• Wounds that are contaminated with soil/ faeces & needs careful cleaning

Contraindications:

• Wound is to digit (distal to MCP/MTP joint), pinna, nasal alae or penis
• Injury is greater than 8 hours old
• Bite, crush or flap wound
• Wound in or near mucosal surface including eye, nose or mouth
• Laceration involves injury to cartilage, bone, joint
• Injury to tendon, nerves or blood vessels
• Previous reaction to local anaesthetic
• History of cholinesterase deficiency

Procedure:

1. Always wear gloves when handling topical anaesthetic
2. Draw up amount of solution to be used in syringe according to age and wound size:
   • Use 1ml of solution per cm of wound length up to maximum allowed
     
   • Maximum amount depends on age:
     • Age 1-3 years 2 ml
     • Age greater than 3 years 3 ml
3. Apply no more than half of solution to edges of wound by dropping from syringe or using cotton applicator
4. Cut swab to appropriate size to cover wound. Soak swab piece with remainder of solution and apply to wound secured firmly with bandage or occlusive dressing
5. Instruct parent/guardian to ensure child does not put dressing into mouth or eyes and to inform staff immediately if dressing becomes loose
6. Inform patient/parents of time for removal (30 minutes after application) and advise them to contact ED staff if they have not been seen by this time.
7. Complete the attached audit form, and file in the patients notes.

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