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Volume 17, Issue 2, Pages 99-107 (April 2009)


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The use of topical anaesthesia during repair of minor lacerations in Departments of Emergency Medicine: A literature review

Carol Little, RGN Adult (Emergency Medicine Sister)aCorresponding Author Informationemail address, Oonagh J. Kelly, Bsc. Hons. Adult Nursing (Emergency Medicine Staff Nurse)a1email address, Mark G. Jenkins, MbChB, FRCS, FCEM (Emergency Medicine Consultant)a2email address, Diarmaid Murphy, MPharm, PhD MPSNI (Research Fellow)b3email address, Paul McCarron, BSc, PhD, MRPSNI, PGCHET (Chair in Pharmaceutics)c4email address

Received 11 August 2008; received in revised form 1 October 2008; accepted 7 October 2008.

Abstract 

Background

There are currently a number of different methods available to obtain anaesthesia in minor dermatological procedures. Although intradermal infiltration of 1% lidocaine is the favoured method for anaesthesia induction in laceration repair, it can cause significant pain in itself. Topical anaesthesia has been investigated as an alternative to infiltration anaesthesia, with the majority of studies looking at preparations of either TAC (tetracaine, adrenaline and cocaine) or LAT (lidocaine, adrenaline and tetracaine).

Methods

A computerised search of the literature was undertaken, using Medline, Cinahl and the Cochrane Library, to identify studies of interest to this review. Reference lists were examined for further relevant papers.

Aims

This paper aims to provide an overview of the use of topical anaesthetics, in laceration repair, in Emergency Medicine (EM) departments.

Conclusion

The literature has shown that the induction of anaesthesia in lacerations has remained largely unchanged over the past few years, with lidocaine infiltration still the preferred method. Many reasons have been put forward as to why topical anaesthetics are not commonly used in the UK. Perhaps it would be beneficial to carry out work in relation to alternative formulations as opposed to overcoming the difficulties associated with formulations that are already available.

a Department of Accident and Emergency Medicine, Antrim Area Hospital, 45 Bush Road, Antrim BT41 2RL, United Kingdom

b School of Pharmacy, Queen’s University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast BT9 7BL, United Kingdom

c Department of Pharmacy and Pharmaceutical Sciences, University of Ulster, Cromore Road, Coleraine, Co. Londonderry BT52 ISA, United Kingdom

Corresponding Author InformationCorresponding author. Tel.: +44 7716449738; fax: +44 2894424160.

1 Tel.: +44 7742257957; fax: +44 2894424160.

2 Tel.: +44 2894424259; fax: +44 2894424160.

3 Tel.: +44 2890972333; fax: +44 2890247794.

4 Tel.: +44 8700400700; fax: +44 2894424160.

PII: S1755-599X(08)00118-3

doi:10.1016/j.ienj.2008.10.002


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