Lidocaine-Epinephrine-Tetracaine Gel Is More Efficient than Eutectic Mixture of Local Anesthetics and Mepivacaine Injection for Pain Control during Skin Repair in Children: A Prospective, Propensity Score Matched Two-Center Study

Abstract

Introduction Skin lacerations are common in children and their repair is a very unpleasant experience for a child. While pain management has been recognized as a key element of high-quality patient care, recent studies report that pain management in the pediatric emergency departments is still suboptimal. Lidocaine-epinephrine-tetracaine (LET) gel could potentially improve the traumatic experience caused by skin repair as it obviates the need for infiltration. Thus, the aim of the current study was to compare local eutectic mixture of local anesthetics (EMLA) plus mepivacaine infiltration with topical anesthetics (LET-gel). Materials and Methods Prospective, propensity score-matched multicenter study including all children between 3 and 16 years presented at two centers. After anesthetics (LET vs. EMLA and infiltration) standardized skin repair was performed. Pain assessment was performed using the faces pain rating scale or visual analogue scale. Follow-up, performed 2 weeks after initial presentation, assessed wound infection rates and overall satisfaction. Results Of 73 subjects 59 children (37 LET vs. 22 EMLA) were included after propensity score matching. Groups had similar baseline characteristics. Pretreatment was significantly less painful in LET versus local anesthetics group. Pain during skin repair was similar between groups (LET and EMLA with mepivacaine infiltration) and both groups demonstrated similar efficacy (procedure time, need for secondary infiltration, infection rate). Ultimately, pain levels during pretreatment and the surgical procedure were perceived significantly higher by the children than estimated by parents or surgeons. Conclusion In conclusion, it appears that LET is superior to conventional anesthesia including mepivacaine infiltration in the pediatric emergency departments. Pretreatment with LET is significantly less painful but equally effective. Hence, we recommend LET as a topical anesthetic in the pediatric emergency department.

Wilderness Medical Society Clinical Practice Guidelines for the Treatment of Acute Pain in Austere Environments: 2024 Update

“…The efficacy and safety of these formulations have been demonstrated for the treatment of wounds and stings and for the facilitation of laceration repairs. 143,144 The efficacy of these formulations outside of recommended storage temperatures of 0–30° C has not been studied and may limit their use in some austere environments.…”

Efficacy of Emla (Eutectic Mixture of Local Anaesthetics) and Let (Lidocaine, Epinephrine, Tetracaine) for Topical Use in Wound Management for Children: A Systematic Review and Meta-Analysis

“… Königs et al,2019 [ 10 ], Harman et al,2013 [ 11 ], Schilling et al,1995 [ 12 ], Singer et al,2000 [ 13 ], Kargi et al,2010 [ 14 ], Zempsky et al,1997 [ 15 ], de Waard-van der Spek et al,1990 [ 16 ], Usmani et al,2009 [ 17 ] …”

“… Königs et al,2019 [ 10 ], Harman et al,2013 [ 11 ], Zempsky et al,1997 [ 15 ], de Waard-van der Spek et al,1990 [ 16 ], Usmani et al,2009 [ 17 ] …”

“…Apart from pain reduction, patient satisfaction has also been used to evaluate the efficacy of LET. Königs et al [ 10 ] reported that overall satisfaction was excellent for children undergoing skin repair in both LET and EMLA groups. However, the directly measured patient satisfaction after the skin repair procedure was significantly higher among patients that received LET than EMLA (1.59 [0.60] vs. 2.04 [0.90], p = 0.018, respectively).…”

“…It seems as if LET has much more effect on shorter lacerations as compared to longer lacerations. In a study by Königs et al [ 10 ] where the average length of lacerations was 3.31 (1.97) cm, and VAS pain scores of 2.6 (2.0) were recorded in the LET group. On the other hand, a study by Harman et al [ 11 ] where the average laceration length was 1.15 ± 0.60 cm, and the achieved VAS score was 0.50 (0.25-1.50).…”