Lidocaine drip, but not what you think

    NextPrevious

    Lidocaine drip, but not what you think

    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.

    https://lacerationrepair.com/

     

    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.

    • Welcome! This is the website for the Mount Sinai Emergency Ultrasound Division. It serves as an information resource for residents, fellows, medical students and others seeking information about point-of-care ultrasound. There is a lot ofRead more

    • renal handling of water

      If you were on a tea & toast diet, how much water would you need to drink before you develop hyponatremia? I haven’t seen anyone work out the numbers before so here are my calculations. AndRead more

    • acute acidemia physiology

      As alluded to in the first post, don’t be fooled by a “normal” potassium in the setting of DKA because osmotic diuresis and H+/K+ exchange means that total body potassium is actually LOW. You all knowRead more

    • renal handling of potassium

      the first symptom of hyperkalemia is death Earlier post covered temporizing measures to counter hyperkalemia — namely, intracellular shift, increasing cardiac myocyte threshold potential. Give furosemide if the patient still urinates and consider dialysis, but then askRead more

    • bicarbonate revisited

      Previous post reviewed the safety of balanced crystalloids in hyper K. But what was up with serum bicarbonate decreasing with saline administration? This post introduces a new way of looking at the anion gap to possiblyRead more

    • hyperkalemia and balanced crystalloids

      Is it safe to give LR or plasmalyte to a hyperkalemic patient (these balanced crystalloids have 4-5 mEq/L K as opposed to 0 mEq/L K in normal saline)? Postponing the discussion of renal handling of potassium toRead more

    • hyperkalemia physiology

      You’ll likely encounter hyperkalemia on your next Resus / Cardiac shift, and you’ll instinctively treat it. But take a moment to review the fascinating physiology behind the “cocktail”! First, consider how K+ is buffered byRead more

    • Slow down your tachycardia (but not really)

      You’re sitting in resus bemoaning the departure of your most beloved attending when suddenly a patient wheels in without warning. The patient looks relatively stable but the triage RN tells you her heart rate wasRead more

    • Otitis externa: use the ear wick!

      Acute otitis externa (AOE) is a common complaint seen in pediatric as well as adult emergency departments. AOE is typically not accompanied by acute otitis media, although concurrent cases are possible. Also called “swimmer’s ear”Read more

    NextPrevious