1% lignocaine with or without adrenaline slowly infiltrated into the wound (use adrenaline with caution in body parts with end arteries).EMLA®(lidocaine (lignocaine) 2.5% and prilocaine 2.5%) and AnGel®(tetracaine (amethocaine) 4%) are suitable alternatives most effective on limb wounds.ALA (adrenaline (epinephrine)/ lidocaine (lignocaine)/ tetracaine (amethocaine)) gel (Laceraine®) applied directly to wound and covered with an occlusive dressing, 20-30 minutes prior to intervention.Specialist advice from the relevant surgical specialty may be requiredĬonsider sedation (eg nitrous or ketamine) and analgesia in addition to anaesthesia for complete examination, cleaning, and repair of wounds. If in any doubt, discuss with senior emergency clinician. Causes (eg animal or human bites) which require consideration for tetanus prophylaxis and/or antibioticsĪll children with lacerations should be fasted from arrivalĬonsider availability of resources required for optimal outcome, including:.areas with end-arteriolar supply (extremities such as the tip of the nose, fingertips, and ear lobes) require special care.if a flap or area of soft tissue distal to the laceration appears dusky or poorly perfused, the wound requires specialty assessment.Impairment of blood supply to surrounding tissue.if a deep laceration cannot be examined adequately to exclude damage to such structures, refer for relevant surgical specialty advice.in the face, remember facial nerve, parotid/ lacrimal ducts, medial canthus of the eye.Injury to deeper structures (eg tendons, joints or nerves).Associated injuries (eg head/ cervical spine in falls, eye in facial trauma, teeth with mouth injuries).Contamination by dirt or foreign bodies.A poor result may be achieved in children who are distressed Treatment should be aimed at the best functional and cosmetic result, with the least distress to the child.Minor lacerations are extremely common in childhood, and there are different methods of management available.Use absorbable sutures where clinically appropriate
Children that require sedation for wound closure may need similar for removal of sutures.Ensuring suitable analgesia and anaesthesia (local +/- sedation) will improve wound outcomes (function, risk of infection, and cosmesis), as well as the child’s experience.Lacerations require thorough assessment prior to closure.Acute pain management Procedural sedation Management of tetanus-prone wounds Key points
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