LET versus EMLA for pretreating lacerations: a randomized trial.
Author(s): Singer AJ, Stark MJ.
Affiliation(s): Department of Emergency Medicine, State University of New York at Stony Brook,
Stony Brook, NY 11794-7400, USA. asinger@epo.som.sunysb.edu
Publication date & source: 2001, Acad Emerg Med. , 8(3):223-30
OBJECTIVE: To compare the anesthetic efficacy of EMLA cream (eutectic mixture of
local anesthetics) with that of LET solution (lidocaine, epinephrine, tetracaine)
for pretreating lacerations prior to lidocaine injection.
METHODS: This was a randomized, double-blind clinical trial in a convenience
sample of 60 patients aged 1 to 59 years with traumatic lacerations. Eligible
wounds were uncomplicated, clean lacerations < or = 6 hours old. Finger and toe
lacerations were excluded. At the time of initial presentation to triage,
patients were randomized to LET or EMLA. A nurse applied the topical anesthetic
into the laceration with a 5-mL syringe. A physician assessed the laceration
edges for the presence of blanching and adequacy of anesthesia to a 27-gauge
needlestick. Supplemental lidocaine was then infiltrated through the wound edges
and the pain of infiltration was recorded by the patient (or guardian) on a
100-mm visual analog scale marked "most pain" at the high end. A sample of 44
patients had 90% power to detect a 20-mm difference in injection pain (two-tailed
alpha = 0.05).
RESULTS: Sixty patients were randomized to LET (29) or EMLA (31). Median age was
8.5 years; 23% were female. Most lacerations were facial and closed with sutures.
There was no difference in baseline characteristics between groups. More wounds
treated with LET were anesthetic to a needlestick than wounds treated with EMLA
(73% vs 40%, p = 0.01); however, there was no between-group difference in the
median pain of lidocaine infiltration (LET-12 mm vs EMLA-13 mm, p = 0.89).
CONCLUSIONS: Pretreatment of simple lacerations with LET or EMLA at the time of
patient presentation results in similar amounts of pain of subsequent local
infiltration of lidocaine
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