PT - JOURNAL ARTICLE AU - Harman, Stuart AU - Zemek, Roger AU - Duncan, Mary Jean AU - Ying, Yvonne AU - Petrcich, William TI - Efficacy of pain control with topical lidocaine-epinephrine-tetracaine during laceration repair with tissue adhesive in children: a randomized controlled trial AID - 10.1503/cmaj.130269 DP - 2013 Jan 01 TA - Canadian Medical Association Journal PG - cmaj.130269 4099 - http://www.cmaj.ca/content/early/2013/07/29/cmaj.130269.short 4100 - http://www.cmaj.ca/content/early/2013/07/29/cmaj.130269.full AB - Background: Some children feel pain during wound closures using tissue adhesives. We sought to determine whether a topically applied analgesic solution of lidocaine-epinephrine-tetracaine would decrease pain during tissue adhesive repair. Methods: We conducted a randomized, placebo-controlled, blinded trial involving 221 children between the ages of 3 months and 17 years. Patients were enrolled between March 2011 and January 2012 when presenting to a tertiary-care pediatric emergency department with lacerations requiring closure with tissue adhesive. Patients received either lidocaine-epinephrine-tetracaine or placebo before undergoing wound closure. Our primary outcome was the pain rating of adhesive application according to the colour Visual Analogue Scale and the Faces Pain Scale - Revised. Our secondary outcomes were physician ratings of difficulty of wound closure and wound hemostasis, in addition to their prediction as to which treatment the patient had received. Results: Children who received the analgesic before wound closure reported less pain (median 0.5, interquartile range [IQR] 0.25- 1.50) than those who received placebo (median 1.00, IQR 0.38-2.50) as rated using the colour Visual Analogue Scale (p = 0.01) and Faces Pain Scale - Revised (median 0.00, IQR 0.00-2.00, for analgesic v. median 2.00, IQR 0.00-4.00, for placebo, p < 0.01). Patients who received the analgesic were significantly more likely to re port having or to appear to have a pain-free procedure (relative risk [RR] of pain 0.54, 95% confidence interval [CI] 0.37-0.80). Complete hemostasis of the wound was also more common among patients who received lidocaine-epinephrine-tetracaine than among those who received placebo (78.2% v. 59.3%, p = 0.008). Conclusion: Treating minor lacerations with lidocaine-epinephrine-tetracaine before wound closure with tissue adhesive reduced ratings of pain and increased the proportion of pain-free repairs among children aged 3 months to 17 years. This low-risk intervention may benefit children with lacerations requiring tissue adhesives instead of sutures. Trial registration: ClinicalTrials.gov, no. PR 6138378804.