TOPICAL ANAESTHETIC SOLUTIONS FOR PAIN FREE SUTURE OF LACERATIONS IN THE EMERGENCY ROOM. Dr Sylvie MARTUS, Laurence PONCIN

Transcription

1 Joint Meeting BELAPS, BAPA & BePPa TOPICAL ANAESTHETIC SOLUTIONS FOR PAIN FREE SUTURE OF LACERATIONS IN THE EMERGENCY ROOM Dr Sylvie MARTUS, Laurence PONCIN Dr C. GOMES, Dr M. GLASS, Dr. J. KIEFFER, Dr V. De PAUW, Dr AM. CHIFOREANU, Dr P. PHILIPPE Service de Chirurgie Pédiatrique,, Luxembourg 1

2 BACKGROUND Lacerations = frequent in a paediatric emergency room Usually : local anaesthesia by injection of Lidocaine But : pain, fear and anxiety of shots and syringes 2

3 HISTORY In 1980 : First publication about topical application of a mixture of Tetracaine, Adrenaline and Cocaine «TAC» Pryor GJ et al., Local anesthesia in minor lacerations: topical TAC vs lidocaine infiltration, Ann Emerg Med Nov;9(11):

4 HISTORY Multiple publications demonstrate : Efficiency of topical anaesthetic solutions compared to Lidocaine injection: Easy handling and comfort for the patient Shorter suture time No changes nor oedema of the treated tissues No increase in complications or healing problems Smith GA et al., Comparison of topical anesthetics with lidocaine infiltration during laceration repair in children. Clin Pediatr (Phila). 1997: 36(1), Smith B.C. et al., Topical versus injectable analgesics in simple laceration repair : an integrative review. 2013: 9(6),

5 AIM Because of reported adverse effects of cocaine containing solution Cocaine absorption documented in urine etc Seizure or even death (misuse) Ernst A. et al., Lidocaine Adrenaline Tetracaine gel versus Tetracaine Adrenaline Cocaine gel for topical anesthesia in linear scalp and facial lacerations in children aged 5 to 17 years, Pediatrics 1995: 95(2), Dailey RH. Fatality secondary to misuse of TAC solution. Ann Emerg Med 1988: 172,

6 AIM Compare the efficiency of 2 solutions of topical anaesthesia prepared by our hospital pharmacy: TAC vs LAT Satisfaction questionnaire Parents Patients Nurses Physicians 6

7 Solutions used: TAC (Since 1992) Tetracaine HCl powder : 25 mg Adrenaline 1 : 2.5 cc Cocaine chlorhydrate : 0.5 g NaCl 0.9 % ad : 5 cc LAT (Since 2011) Lidocaine 4 % : 0.2 g Adrenaline 0,5 : 2.5 cc Tetracaine 0,5 % : 25 mg Aqua 7

8 5 CC FLASKS, STERILE DROP-PLUG Stored in a refrigerator and protected from light maximum 6 months 8

9 INDICATIONS Lacerations needing suture handled in the emergency department Preparation of large or deep wounds before injecting Xylocaine 1 % 9

10 CARE PROCEDURE Disinfection of laceration with aqueous Chlorhexidine Dry the wound Drip solution into open wound Sterile compress soaked with anaesthetic solution applied to the wound 10

11 CARE PROCEDURE Fixing with a waterproof dressing 11

12 CARE PROCEDURE Direct contact with the wound assured by compression with a gloved* hand (accompanying person) or compression bandage 20 to 30 minutes *prevent vasoconstriction of holding fingers 12

13 CARE PROCEDURE Application efficient : When the skin around the laceration turns whitish 13

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15 CONTRAINDICATIONS X X X X 15

16 CONTRAINDICATIONS X X Not near the eyes (eyelid) TAC : Not on the lips or the mucosae 16

17 METHOD Prospective study 6 months (3 months : TAC, 3 months : LAT) Questionnaire Pain, anxiety, satisfaction Description of the wound and pain management : Need for supplemental Lidocaine injection? 17

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19 RESULTS 156 charts (age 1 to 15 years) TAC LAT Charts girls 66 boys 24 girls 36 boys < 5 cm 93% 95 % ADDITIONAL ANAESTHESIA 17 % 11 % SATISFACTION Nurses 72 % 71 % Physicians 78 % 77 % Patients and Parents 83 % 98 % TAC and LAT had similar results 19

20 CONCLUSION Topical anaesthesia is a good alternative to the local anaesthetic infiltration Easy Reproducible LAT and TAC = same efficiency but : No cocaine : less side effect, less expensive LAT replaced TAC in our practice 20

21 CONCLUSION Do not forget side effects! Central nervous system : Headache, irritability, restlessness, tingling around the lips, somnolence, blurred vision and seizures Cardiovascular : Bradycardia, decreased contractility, atrioventricular block, vasodilation and cardiac arrest Rare if recommended dose not exceeded! Hsu D.C., Topical anesthetics in children, UpToDate 2015, Apr 16 21

22 CONCLUSION Also useful for wound cleansing (abrasions) Skin glue repair Harman et al., Efficacy of pain control with topical LAT during laceration repair with tissue adhesive in children: a randomized controlled trial, CMAJ 2013: 185(13), Not only for children Vandamme E. et al., LAT gel for laceration repair in the emergence department : not only for children? European Journal of Emergency Medecine 2015: 00,

23 Dank U! Merci! Thank you! 23