Planning Local Anaesthetic Use

Like any medical intervention, local anaesthesia needs proper planning. It is a frequently-used technique and it is easy to become blasé. Initial assessment should be made to determine the correct diagnosis and then choose the right anaesthetic technique.

The age and temperament of the child

• Some children are stoical and brave and will accept painful procedures if spoken to adequately
• Some children are distraught. However, a proportion of these can still be talked around to the required procedure
• Children’s nurses are a huge help, and can assist in managing the child and parents
• Eye contact and a calm voice are essential
• In general do not let them see the needle – but don’t appear secretive

Learning bite

The correct technique will minimise complications.

The temperament of the carer or parent

• Some parents are really helpful and can calm and soothe their children
• Some parents are more upset than the child
• It is generally better to have a parent/carer present, than not, but it can be good to choose the parent who will be most helpful and supportive
• At this age, it is likely that the parent will give consent. At an older age, consider the ability of the child to consent themselves. We examine the subject of consent on the next page

Sedation or general anaesthesia

• If the child/parent will not accept local anaesthesia, an alternative will be necessary. This can include entonox/ketamine/general anaesthesis
• The choice will depend not only on the psychological factors, but also on the skills and abilities of the ED to deliver any specific treatment

Please refer to the Guideline for Ketamine Sedation for Children on the Web Resources page of this session.

Infiltration

• This may be more painful than surface gels and may cause increase psychological upset in children who are afraid of needles. However, it gives the option to add adrenaline, which may help to stop the bleeding
• To some extent you should suture as quickly as possible so that the stress is relieved quickly. Lidocaine may be best for this reason, though bupivacaine will give a longer duration of pain relief
• Consider injecting using an insulin needle if suitable
• Inject slowly and warm and buffer the anaesthetic to reduce pain [2][10]

The agent and route of administration

For faces and scalps, surface anaesthesia through local anaesthetic gels have been found to be as effective as infiltration.