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Needle-less anaesthesia for mucosal lacerations
Background: It is difficult to treat oral mucosal lacerations in children. They are often terrified, in pain, and won't remain still enough to allow safe delivery of local anaesthetic or fine suturing. Lidocaine can either be injected locally or used in a nerve block, but both of these options are tricky in the paediatric population. The authors of the current paper present a novel approach to achieving satisfactory local anaesthesia.
Nickerson J, Tay ET. Dripped lidocaine: a novel approach to needleless anesthesia for mucosal lacerations. J Emerg Med 2018;55(3):405-7
The paper: A case series of 3 children (aged 2, 8 and 15) who presented with lip lacerations. Each received local anaesthesia by dripping 1% lidocaine into the wound at a rate of 1 drop per second until the wound was saturated with solution. Adequate anaesthesia was achieved after around 5 minutes, and each wound was sutured closed with minimum discomfort. The authors hypothesised that the increased blood supply of the oral mucosa meant that the lidocaine was readily absorbed by the wound and surrounding tissue.
The bottom line: If you have a child with an oral mucosal laceration that needs closing, try dripping lidocaine onto the wound to achieve local anaesthesia.
Note: I have personally tried this 3 times (bringing our 'collective case series' to 6!). Twice it worked like a charm. In the last case, there was some discomfort, but I was able to inject some more lidocaine to eliminate this - the drips certainly helped reduce the pain of injection.
Expert commentary:"This technique is useful as LAT gel cannot be used on mucus membranes. The only potential risks are swallowing the solution and reaching the maximum dose for weight. Incidentally, there is no hard-and-fast rule about who can close lacerations across the vermilion border - it's purely about the competence of the practitioner and the agreement of the patient / parent."(Dr Dwynwen Roberts, ED Consultant)
"This is a potentially amazing idea, especially in needle phobic children, ADHD, ASD, etc."(Dr Mohsin Jafri, Paediatric Consultant)
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By Barrie StevensonBackground: It is difficult to treat oral mucosal lacerations in children. They are often terrified, in pain, and won't remain still enough to allow safe delivery of local anaesthetic or fine suturing. Lidocaine can either be injected locally or used in a nerve block, but both of these options are tricky in the paediatric population. The authors of the current paper present a novel approach to achieving satisfactory local anaesthesia.
Nickerson J, Tay ET. Dripped lidocaine: a novel approach to needleless anesthesia for mucosal lacerations. J Emerg Med 2018;55(3):405-7
The paper: A case series of 3 children (aged 2, 8 and 15) who presented with lip lacerations. Each received local anaesthesia by dripping 1% lidocaine into the wound at a rate of 1 drop per second until the wound was saturated with solution. Adequate anaesthesia was achieved after around 5 minutes, and each wound was sutured closed with minimum discomfort. The authors hypothesised that the increased blood supply of the oral mucosa meant that the lidocaine was readily absorbed by the wound and surrounding tissue.
The bottom line: If you have a child with an oral mucosal laceration that needs closing, try dripping lidocaine onto the wound to achieve local anaesthesia.
Note: I have personally tried this 3 times (bringing our 'collective case series' to 6!). Twice it worked like a charm. In the last case, there was some discomfort, but I was able to inject some more lidocaine to eliminate this - the drips certainly helped reduce the pain of injection.
Expert commentary:"This technique is useful as LAT gel cannot be used on mucus membranes. The only potential risks are swallowing the solution and reaching the maximum dose for weight. Incidentally, there is no hard-and-fast rule about who can close lacerations across the vermilion border - it's purely about the competence of the practitioner and the agreement of the patient / parent."(Dr Dwynwen Roberts, ED Consultant)
"This is a potentially amazing idea, especially in needle phobic children, ADHD, ASD, etc."(Dr Mohsin Jafri, Paediatric Consultant)