The practice of using EMLA or LET cream on a wound that is about to be cleansed, explored and sutured is common, especially in the PEDs world. However, both of these options take time to work, which can be a significant barrier to use during a busy shift.
A paper published in October 2018 (see reference below) suggests that dripping 1-2 mL lidocaine onto the wound just before suturing may actually decrease patient perception of pain. The science behind this has less to do with pharmacokinetics (there is no direct anesthetic effect) and more to do with the touch and temperature effects on the transmission of pain signals through A-delta and C fibers (Step 1 flashback!). Although this randomized controlled study is on the smaller side (n=481), they found a 26% relative reduction in procedural pain.
So, next time you are about to suture something, consider using a couple mL anesthetic on the wound before you start. It won’t hurt anything, it’s fast, it’s easy, and it might make the ED experience a little better for your patient.
Additional info:
I know I sent this out last week, but here is the link for Closing the Gap once again. It’s a great resource for refining your suture skills, plus additional info on some other topics as well.
Reference:
Comparison of Two Lidocaine Administration Techniques on Perceived Pain From Bedside Procedures: A Randomized Clinical Trial. Chest. 2018 Oct;154(4):773-780. doi: 10.1016/j.chest.2018.04.018. Epub 2018 Apr 24.
