LAT gel topical anaesthetic for paediatric wounds

LAT gel solution: 4% lidocaine, 0.1% adrenaline, 0.5% tetracaine gel topical anaesthetic preparation.

 Supplied in 3ml vials.

Evidence:

LAT can be used in preference to injected lidocaine, being less painful and equi-analgesic: Grade A (Ernst et al. 1997; Smith et al, 1998; White et al, 2004; Eidelman et al, 2005a).

LAT gel can be used pre-treatment with injected lidocaine to reduce the pain of subsequent injection: grade B (Singer and Start, 2000; 2001).

• Children 1 year and older.
• Laceration requiring exploration, cleaning, debridement or suturing in the ED.

• Wound in digit, pinna, nasal alae, penis.
• Lacerations older than 8 hours.
• Bite, crush or flap wound.
• Wound in or near mucosal surface including eye, nose or mouth.
• Previous reaction to local anaesthetic.
• History or cholinesterase deficiency.

1. Draw up amount of solution to be used in syringe according to age and wound size.
2. Use 1ml of solution per cm of wound length up to maximum allowed.
3. Maximum amount depends on age:
   • Age 1-3 years - 2ml
   • Over 3 years - 3ml

4. Apply 50% of solution to edges of the wound by dropping from syringe or using cotton applicator:

5. Cut swab to appropriate size to cover wound. Soak swap piece with remaining 50% of solution.

6. Apply to wound secured firmly with occlusive dressing +/- bandage.

7. After 20-30 minutes remove dressing and assess wound for adequacy of analgesia by blanching and response to pin prick with 27G needle. Skin edges should appear blanched.

8. If further anaesthetic is required, infiltrate buffered 1% lidocaine up to a maximum of 0.3ml/kg.