Expanding the use of topical anesthesia in wound management: sequential layered application of topical lidocaine with epinephrine

Topical anesthesia eliminates the need for injection of anesthetic. Most studies on the use of topical anesthesia were done on children, using 3 active ingredients (lidocaine, epinephrine, tetracaine, or tetracaine, adrenaline, cocaine) for relatively small wounds of the face and scalp. Objectives: To demonstrate that topical anesthesia is effective and safe in adults of all ages and for larger wounds, using a preparation with 2 active ingredients, topical lidocaine and epinephrine (TLE). Methods: One hundred patients were enrolled in a randomized controlled trial, with 50 in each group. The study group received TLE using a unique method of sequential layered application. The control group received 2% lidocaine infiltration anesthesia. Patients rated the pain from the application of anesthesia and from suturing, using a 0 to 10 visual analog pain scale. Follow-up interviews were conducted to assess for complications and to rate patients' wound repair experience. Results: Patients in the study group reported significantly less pain from TLE application, with 66% reporting no pain vs 0% reporting no pain from the infiltration in the control group (P <.001). There was no difference in pain during wound repair between the 2 groups (P similar to .59). On follow-up, 95% of patients contacted in the TLE group rated their experience in regard to pain as excellent, compared to 5% of patients in the control group (P <.001). Conclusion: Topical lidocaine and epinephrine sequential layered application is an effective, safe, and less painful method of anesthesia for a wide variety of lacerations. Patients recall their experience with this technique very favorably. (C) 2007 Elsevier Inc. All rights reserved.