SCOPE OF THE PROBLEM

Lacerations are one of the most common presenting complaints in the emergency department. Although decreased from a decade previously, it has been estimated that over 7 million patients with lacerations were treated in EDs in 2002. Local anesthesia is utilized for the repair of most lacerations. Minimizing the pain and risk of local anesthesia administration has obvious merit.

CLINICAL ASSESSMENT

Patients who have suffered even minor lacerations may be emotionally traumatized and anxious when presenting to the ED for care. It is therefore important to maintain a calming supportive environment while taking a few minutes to allay patients' anxiety and address their concerns. Several steps can be taken to minimize pain associated with anesthetic administration.

In addition to minimizing the pain associated with injection, physicians must also minimize the risk associated with the administration of local anesthesia. This is accomplished by attention to proper technique, not exceeding maximum safe doses, avoiding intravascular administration, proper use of anesthetics with epinephrine, and avoiding agents to which the patient has a known allergy.

PAIN/SEDATION CONSIDERATIONS

Even the most stoic-appearing patients may be concerned about pain associated with injection of anesthesia. One study reported beneficial effects of allowing patients to listen to music during laceration repair. Patients who listened to music during laceration repair reported less pain and anxiety (though only the former reached statistical significance) than those who did not.