Topical Anesthetic for Laceration Repair in Children

The objective of this study is to evaluate the impact of the introduction of an education program familiarizing staff with the effective and appropriate use of Laceraine application to children's lacerations requiring repair at The Prince Charles Hospital Children's Emergency Department (TPCH-CED), Brisbane.

A retrospective audit was performed using data obtained from the local emergency department information system (EDIS) and a paper chart audit, for all presentations to TPCH-CED during 2015 and 2020 requiring laceration repair.

Of the 20,813 registered patients to TPCH-CED in 2015, 993 (4.8%) required laceration repair, compared with 1756 (5.6%) of the 31,059 registered in 2020 demonstrating that presentations to the CED requiring laceration repair increased, as a proportion of overall presentations, reaching statistical significance across all groups ( P < 0.001). The percentage of lacerations requiring repair that had Laceraine applied (either as a single agent or in combination) was 59% in 2015 and 93% in 2020 ( P < 0.001). There was a significant increase in use of Laceraine only as agent of choice.

There was a significant change in practice with greater use of topical anesthetic (Laceraine) for the management of laceration repair of children, as expected, after the focused education program on its correct use. As emergency departments continue to be overwhelmed with increasing attendances and long patient wait times, a simple small intervention, such as that described, has potential to improve flow through the children's emergency department. Future research should focus on a randomized control trial to determine the contribution of the use of a topical agent, as opposed to injectable local anesthetic and/or full procedural sedation to determine the contribution to the impact of this simple change of practice on patient flow and satisfaction.