LAT gel, a powerful tool underused in the repair of paediatric lacerations

Abstract

Paediatric lacerations presenting to emergency departments are a common cause of referral to surgical specialties in the UK. LAT gel (lidocaine, adrenaline, and tetracaine) is a safe and effective topical anaesthetic that can aid with the closure of uncomplicated lacerations, particularly in the paediatric trauma setting. The benefits to both the patient and management in terms of the avoidance of a general anaesthetic and the freeing up of hospital resources (e.g. beds, staffing, emergency theatre) make it an invaluable tool in the arsenal of the emergency department. The authors describe a reliable method of anaesthetizing lacerations with LAT gel and question its underuse within the emergency departments in the South West region of the UK.

The debridement and suturing of lacerations in the emergency department is a daunting experience for the paediatric patient and their parents alike. The sight of a needle alone can induce stress, poor cooperation, and refusal for treatment in the child that may result in a general anaesthetic. For simple lacerations, it is preferable to avoid a general anaesthetic as it is not without risk and is a burden on the emergency theatre, staffing, and beds. The National Institute for Health and Care Excellence estimates the cumulative costs to the National Health Service (NHS) for half an hour of general anaesthesia per child to average 229 GBP per session.

LAT gel (lidocaine, adrenaline, and tetracaine) has been reported to be as effective and safer than its predecessor TAC gel (tetracaine, adrenaline, and cocaine). When appropriately used with behavioural management techniques it can greatly aid in the closure of simple lacerations of the head, limbs, or torso without the need for further anaesthesia. We expand on a reliable technique described by McNulty et al. for the closure of lacerations in anxious children unable to accept a local infiltration. Additionally we review the current use of topical anaesthetics in the emergency departments of the South West region of the UK.

Materials and methods

LAT sterile gel used in our emergency department is composed of 4% lidocaine, 0.1% adrenaline, and 0.5% tetracaine hydrochloride. It is applied topically to laceration wounds secured with an adhesive dressing (e.g. Opsite; Smith & Nephew Healthcare Ltd, Hull, UK) and left in situ for a maximum of 30 min to take effect. According to the manufacturer’s instructions, the recommended dosage is 0.5 ml per cm of wound length, up to a maximum of 2 ml for those aged 1–3 years and 3 ml for those over 3 years. Following removal of the dressing, the wound margins are sufficiently anaesthetized to allow debridement and the direct placement of sutures without the further need for a local infiltration. The mean working time for the duration of effective anaesthesia using LAT gel is approximately 20 min. For more extensive lacerations, LAT gel facilitates the less painful administration of a local infiltration into the wound, thereby eliminating the uncomfortable initial penetration of the needle and burning sensation frequently associated with injections.

We contacted all emergency departments with surgical specialties in the South West UK to enquire if LAT gel was available in their unit for use in laceration closure.

Results

In the South West UK, a total of 19 hospitals offer 24-h paediatric emergency services with surgical specialties. All emergency departments in this region are operated under the NHS. Just under half of these emergency departments stocked LAT gel (47%), one third stocked TAC gel (32%), and one fifth stocked neither (21%). Of the units that did not stock LAT gel, none were able to comment on why. All emergency departments investigated stocked some form of topical anaesthetic suitable only for application to intact skin, e.g. EMLA cream (eutectic lidocaine–prilocaine), Ametop gel (tetracaine), Instillagel (lidocaine).

Results

In the South West UK, a total of 19 hospitals offer 24-h paediatric emergency services with surgical specialties. All emergency departments in this region are operated under the NHS. Just under half of these emergency departments stocked LAT gel (47%), one third stocked TAC gel (32%), and one fifth stocked neither (21%). Of the units that did not stock LAT gel, none were able to comment on why. All emergency departments investigated stocked some form of topical anaesthetic suitable only for application to intact skin, e.g. EMLA cream (eutectic lidocaine–prilocaine), Ametop gel (tetracaine), Instillagel (lidocaine).

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Jan 19, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on LAT gel, a powerful tool underused in the repair of paediatric lacerations
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