Acute Traumatic Wounds, Lacerations, Pain Management, Wound Repair
Conditions
Keywords
Topical anaesthesia, LAT gel, Laceration repair, Local anaesthesia, Lidocaine infiltration, Pain measurement, Emergency department, Adult trauma
Brief summary
This prospective comparative study evaluates pain experience in adult patients undergoing laceration repair in the emergency department using either topical lidocaine-adrenaline-tetracaine (LAT) gel or lidocaine infiltration as local anaesthesia. Lidocaine infiltration is the standard anaesthetic technique for wound repair but can cause significant pain during injection. LAT gel is a needle-free topical anaesthetic that is widely used in paediatric patients but has been less studied in adults. Adult patients presenting with simple lacerations requiring suturing are allocated to receive either LAT gel or lidocaine infiltration according to the clinical judgement of the treating physician. Pain is measured using a visual analogue scale (VAS) during anaesthetic administration, during testing of anaesthetic effectiveness, and during suturing. Additional variables include wound characteristics, patient characteristics, and the need for additional anaesthesia. The study aims to evaluate whether LAT gel provides comparable pain control while reducing pain during anaesthetic administration.
Detailed description
Pain management is an important component of wound treatment in the emergency department. Local anaesthesia is routinely required for laceration repair, most commonly using infiltrative anaesthesia with lidocaine. Although effective, lidocaine infiltration can cause significant discomfort due to the injection itself and may increase patient anxiety. In addition, infiltration can sometimes distort tissue and potentially complicate the suturing procedure. Alternative approaches that reduce pain during anaesthetic administration may therefore improve patient comfort during wound management. Topical anaesthesia using lidocaine-adrenaline-tetracaine (LAT) gel represents a needle-free alternative to infiltrative anaesthesia. LAT gel is commonly used in paediatric patients and has demonstrated effectiveness in reducing pain during laceration repair. However, evidence regarding its use in adult patients remains limited. Evaluating the effectiveness of LAT gel in adults may help determine whether it can be used more broadly as an alternative to injection-based anaesthesia in the emergency department. This prospective comparative study includes adult patients presenting to the emergency department of Universitair Ziekenhuis Brussel with simple lacerations requiring suturing. Patients receive either LAT gel or lidocaine infiltration as local anaesthesia according to the clinical judgement of the attending physician. Pain experience is measured using a visual analogue scale (VAS) during anaesthetic administration, during testing of anaesthetic adequacy, and during suturing. Additional variables recorded include patient characteristics, wound characteristics, suturing characteristics, the need for additional anaesthesia, and procedure-related complications. The aim of the study is to compare pain experience between both anaesthetic techniques and to assess whether LAT gel may represent a suitable alternative for selected adult lacerations.
Interventions
DRUGLidocaine-Adrenaline-Tetracaine (LAT) Gel
LAT gel (lidocaine 4%, adrenaline 0.1%, tetracaine 0.5%) is applied directly into the wound at a dose of approximately 0.5 mL per centimetre of wound length and covered with an occlusive dressing for 30 minutes prior to suturing.
Subcutaneous infiltration of lidocaine 1% is administered locally around the wound approximately 5 minutes prior to suturing.
Sponsors
Vrije Universiteit Brussel
Universitair Ziekenhuis Brussel
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Prospective comparative study conducted in the emergency department of Universitair Ziekenhuis Brussel. Adult patients with simple lacerations requiring suturing receive either topical lidocaine-adrenaline-tetracaine (LAT) gel or lidocaine infiltration based on the clinical judgement of the attending physician.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥ 18 years * Presentation to the emergency department with a simple laceration requiring suturing * Laceration length less than 7 cm * Ability to provide informed consent * Ability to report pain using a visual analogue scale (VAS)
Exclusion criteria
* Suspected tendon injury or nerve injury * Wounds located on mucosal surfaces * Wounds located on ears, nose, or genital area * Known allergy to local anaesthetic agents * Pregnancy * Severe cardiac or pulmonary disease * Drug intoxication or altered mental status * Sedation with nitrous oxide * Psychiatric disorder interfering with pain reporting * Language barrier preventing informed consent or pain assessment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain during suturing | During suturing procedure | Pain experienced during wound suturing measured using a 100 mm visual analogue scale (VAS). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain during anaesthetic administration | At time of anaesthetic administration | Pain experienced during administration of the anaesthetic (LAT gel application or lidocaine infiltration) measured using a visual analogue scale (VAS). |
| Pain during testing of anaesthetic effectiveness | After waiting period for anaesthesia (30 minutes LAT gel / 5 minutes lidocaine) | Pain experienced during testing of anaesthetic adequacy using a needle prick, measured using a visual analogue scale (VAS). |
Countries
Belgium
Outcome results
None listed