Topical anesthetic cream vs. lidocaine infiltration for superficial laceration repair in the emergency department: a randomized clinical trial
Abstract
Background and importance: Superficial skin lacerations requiring local anesthesia before suture are common in emergency departments (EDs). Lidocaine infiltration is effective but involves needle use, which may cause pain, discomfort, and increase patient anxiety. Topical anesthetic cream offers a needle-free alternative, yet comparative evidence in adult ED populations remains limited.
Objectives: To compare the analgesic efficacy of topical anesthetic cream with lidocaine infiltration for anesthesia during the repair of superficial skin lacerations in adult ED patients.
Design: Randomized, open-label, superiority multicentric clinical trial.
Settings and participants: The study was conducted in two EDs in France. Adult patients presenting with a superficial laceration requiring suturing were eligible.
Intervention: Participants were randomized to receive either topical anesthetic cream applied before the procedure (a eutectic mixture of lidocaine 2.5% and prilocaine 2.5%) (intervention group) or standard lidocaine infiltration for local anesthesia (control group).
Outcome measures and analysis: The primary outcome was the maximum pain experienced throughout the waiting, preparation, and suturing phases, measured using a Numeric Rating Scale (NRS: 0-10). Secondary endpoints were patient and provider satisfaction, rescue infiltrations, the patients' self-assessment of their maximum pain during each phase, ED length of stay, 15-day adverse effects, and wound healing. Analyses…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 126 participants or records.
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