Minimizing the pain of local infiltration anesthesia for wounds by injection into the wound edges

doi:10.1016/0736-4679(94)90408-1

The Journal of Emergency Medicine

Volume 12, Issue 5, September–October 1994, Pages 593-595

https://doi.org/10.1016/0736-4679(94)90408-1 Get rights and content

Abstract

This study on low contamination wounds was conducted to compare the pain of local infiltration anaesthesia administered into the skin surrounding the wound with administration directly into the incised edges of the wound. Eighty-one adult patients were randomized by date of presentation to receive infiltration anesthesia by one of the two methods. Pain of anesthetic administration was rated on a visual analogue scale and recorded as a pain score in millimeters. The results demonstrated that the average pain score for infiltration into the wound was significantly lower than the average pain score for infiltration into skin surrounding the wound.

References (12)

K.A. Arndt et al.
Minimising the pain of local anaesthesia
Plast Reconstruc Surg.
(1983)
R.A. Christoph et al.
Pain reduction in local anesthetic administration through pH buffering
Ann Emerg Med.
(1988)
A.B. Anderson et al.
Local anesthesia in pediatric patients: topical TAC versus lidocaine
Ann Emerg Med.
(1990)
M.A. Hegenbarth et al.
Comparison of topical tetracaine, adrenaline and cocaine anesthesia with lidocaine infiltration for repair of lacerations in children
Ann Emerg Med.
(1990)
R.F. Edlich et al.
Anaesthesia for wound repair
D.H. Wilson et al.
Accident and emergency handbook
(1985)

There are more references available in the full text version of this article.

Cited by (23)

Laceration Management
2017, Journal of Emergency Medicine
Citation Excerpt :
When the solution is both warmed and buffered, the effects are synergistic (57). Injection through the wound edges is significantly less painful than injection through intact skin (61,62). Using a slower speed of injection does not reduce pain (63,64).
Traumatic lacerations to the skin represent a fairly common reason for seeking emergency department care. Although the incidence of lacerations has decreased over the past decades, traumatic cutaneous lacerations remain a common reason for patients to seek emergency department care.
Innovations in laceration management have the potential to improve patient experience with this common presentation.
Studies have confirmed that delays in wound closure rarely confer increased rates of infection, although comorbidities such as diabetes, chronic renal failure, obesity, human immunodeficiency virus, smoking, and cancer should be considered. Antibiotics should be reserved for high-risk wounds, such as those with comorbidities, gross contamination, involvement of deeper structures, stellate wounds, and selected bite wounds. Topical anesthetics, which are painless to apply, have a role in select populations. In most studies, absorbable sutures perform similarly to nonabsorbable sutures and do not require revisit for removal. Novel atraumatic closure devices and expanded use of tissue adhesives for wounds under tension further erode the primacy of regular sutures in wound closure. Maintaining a moist wound environment with occlusive dressings is more important than previously thought. Most topical wound agents are of limited benefit.
Recent innovations in wound closure are allowing emergency physicians to shift toward painless, atraumatic, and rapid closure of lacerations.
Wound Management
2012, Critical Care Nursing Clinics of North America
Citation Excerpt :
These sites include the fingers, toes, the tip of the nose, pinna, and penis. The pain of local infiltration can be diminished by injecting subcutaneously through the open wound edge instead of directly into intact skin16,17 with the smallest needle possible. Although 30-gauge needles can be used for direct infiltration, 25- or 27-gauge needles are better suited for regional nerve blocks to decrease the possibility of deflection of the needle.18
Wound Cleansing and Irrigation
2012, Wounds and Lacerations: Emergency Care and Closure
Current management of wounds in Angers emergency department: Comparison of the practices to the recommendations of the French consensus conference of Clermont-Ferrand of december 2005
2010, JEUR
En 2005, la prise en charge des plaies aux urgences a fait l’objet d’une conférence de consensus. Notre objectif était de comparer la prise en charge des plaies au SAU d’Angers aux recommandations de cette conférence.
Étude prospective, descriptive, monocentrique rentrant dans le cadre d’une étude de pratiques professionnelles. Les critères d’inclusion étaient : motif principal ou secondaire d’admission aux urgences pour « plaie ». Les données étaient recueillies par l’opérateur à partir d’un questionnaire déposé dans le dossier du patient. Ce questionnaire permettait d’évaluer 13 étapes de la prise en charge technique. Le critère de jugement principal de l’étude était le pourcentage de non-conformité des dossiers à cette conférence.
Cent quatre-vingt-cinq patients ont été inclus sur une période de deux mois. Le pourcentage moyen de non-conformité des dossiers à la conférence de consensus était de 32 ± 16 %. Le lavage des plaies n’était pas conforme à la conférence dans plus de la moitié des dossiers (94/185). Il était moins fréquemment réalisé sur la période de garde (p < 0,05). En cas d’indication, le parage était moins souvent réalisé par les étudiants que par les internes et les seniors (p < 0,01). Il n’était pas conforme à la conférence de consensus dans près d’un quart des cas (39/169). L’anesthésie locorégionale de la face était exceptionnellement utilisée.
La prise en charge des plaies au SAU d’Angers est parfois inadéquate et justifie une intervention d’amélioration des pratiques sur les items les moins maîtrisés. L’effet de cette intervention devra ensuite être évalué.
In 2005, the management of facial wounds in the emergency ward was the subject of a French consensus conference. Our objective was to compare the management of wounds in the emergency ward of Angers hospital with the recommendations of the consensus conference (“guidelines”).
Prospective, descriptive and monocentric professional practice evaluation study. The inclusion criteria were: principal or secondary grounds for admission in the emergency ward for “wound”. The data was gathered from a questionnaire included in the patients file on admission to the emergency department. That questionnaire allowed evaluation of the different steps in the technical management of a wound. The main criterion of the study was the percentage of non-conforming files in comparison to the consensus conference guidelines.
One hundred and eighty-five patients were included on a 2-month period. The average percentage of non-conforming files in comparison to the consensus conference guidelines was 32 ± 16 %. The wound cleaning was not in accordance with the guidelines in more than half of the files (94/185). It was less frequently performed during the night and weekend duty-periods (p < 0.05). When indicated, the debridement was less frequently performed by students than by residents and senior physicians (p < 0.01). In almost a quarter of cases, it was not in accordance with the consensus conference guidelines (39/169). Facial nerve block was exceptionally used.
Wound management in the emergency ward of Angers hospital is sometimes inadequate. Therefore, it seems important to develop a training program aimed at improving the least mastered skills. A second study will be lead after the implementation of these training aids.
The use of topical anaesthesia during repair of minor lacerations in Departments of Emergency Medicine: A literature review
2009, International Emergency Nursing
There are currently a number of different methods available to obtain anaesthesia in minor dermatological procedures. Although intradermal infiltration of 1% lidocaine is the favoured method for anaesthesia induction in laceration repair, it can cause significant pain in itself. Topical anaesthesia has been investigated as an alternative to infiltration anaesthesia, with the majority of studies looking at preparations of either TAC (tetracaine, adrenaline and cocaine) or LAT (lidocaine, adrenaline and tetracaine).
A computerised search of the literature was undertaken, using Medline, Cinahl and the Cochrane Library, to identify studies of interest to this review. Reference lists were examined for further relevant papers.
This paper aims to provide an overview of the use of topical anaesthetics, in laceration repair, in Emergency Medicine (EM) departments.
The literature has shown that the induction of anaesthesia in lacerations has remained largely unchanged over the past few years, with lidocaine infiltration still the preferred method. Many reasons have been put forward as to why topical anaesthetics are not commonly used in the UK. Perhaps it would be beneficial to carry out work in relation to alternative formulations as opposed to overcoming the difficulties associated with formulations that are already available.
Wound Management
2007, Emergency Medicine Clinics of North America
Citation Excerpt :
These sites include the fingers, toes, the tip of the nose, pinna, and penis. The pain of local infiltration can be diminished by injecting subcutaneously through the open wound edge instead of directly into intact skin [16,17] with the smallest needle possible. Although 30-gauge needles can be used for direct infiltration, 25- or 27-gauge needles are better suited for regional nerve blocks to decrease the possibility of deflection of the needle [18].
Wound management makes up an important part of the emergency physician's practice. Understanding the physiology of wound healing and the patient and wound factors affecting this process is essential for the proper treatment of wounds. There are many options available for wound closure. Each modality has its benefits and its drawbacks, and some are appropriate only for certain types of wounds. The goal is to achieve the best functional and cosmetically appealing scar while avoiding complications.

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Original contributionMinimizing the pain of local infiltration anesthesia for wounds by injection into the wound edges

Abstract

Minimising the pain of local anaesthesia

Plast Reconstruc Surg.

Pain reduction in local anesthetic administration through pH buffering

Ann Emerg Med.

Local anesthesia in pediatric patients: topical TAC versus lidocaine

Ann Emerg Med.

Comparison of topical tetracaine, adrenaline and cocaine anesthesia with lidocaine infiltration for repair of lacerations in children

Ann Emerg Med.

Anaesthesia for wound repair

Accident and emergency handbook

Original contribution
Minimizing the pain of local infiltration anesthesia for wounds by injection into the wound edges