Application of Let Solution for Wound Anaesthetic

NURSING DEPARTMENT

Approved by: Number: (Replacing T.A.C P+P) Title: Program Director, Emergency & Ambulatory Care

Date: 03:01 (O) Dist: Emergency

PROCEDURE: APPLICATION OF LET SOLUTION FOR WOUND ANAESTHETIC (Lidocaine, Epinephrine and Tetracaine Solution)

PURPOSE: To effect wound anesthesia in preparation for suture repair.

Recommended only for use on face and scalp (not extremities) as ordered by physician. Do not use for patients with allergy to esters or amides anesthetics. Do not use where absorption may be increased including:  burned or denuded skin  mucous membrane of nose, mouth or eyes. Do not use if there are contraindications to vasoconstrictor use including:  lacerations more than eight hours old or that are grossly contaminated  pinna of the ear, nasal alae, digits or penis.

EQUIPMENT: 1. Capped 3ml syringe with LET solution. 2. Cotton ball or gauze square. 3. Tape. 4. Gloves.

PROCEDURE: 1. Cleanse wound according to routine. 2. Pull cotton ball / cut gauze 25 - 50% larger than wound to act as a “wick”. 3. Pour LET onto wick 4. Prevent LET solution contact with mucous membrane by using a gauze barrier. 5. Apply tape lightly over wick to hold in place or hold wick in place wearing gloves. 6. If after 20 minutes anesthesia is not adequate, may require 1% Lidocaine injection. 7. Document patient response and appearance of wound in interdisciplinary progress notes.

REFERENCES: Dubinsky, I. (1998). Practice tips: Topical LET solution works well for repair of lacerations. Canadian Family Physician, March, 505. Ernst, A. A., & Marves-Valls, E. (1995). LAT (Lidocaine-Adrenaline-Tetracaine) versus TAC (Cetracaine-Adrenaline-Cocaine) for topical anesthesia in face and scalp lacerations. American Journal of Emergency Medicine, 13(2), 151-154. Schilling, C. G., & Bank, D. E. (1995). Tetracaine, epinephrine (Adrenalin), and cocaine (TAC) versus lidocaine, epinephrine, and teracaine (LET) for anesthesia of lacerations in children. Annals of Emergency Medicine, 25, 203-208.