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背景有些儿童在用组织粘合剂修复伤口时感觉疼痛。此研究对组织粘合剂修复伤口时,局部用利多卡因-肾上腺素-丁卡因止痛溶剂,缓解疼痛的效果做出了评价。方法此研究为随机、安慰剂-对照、参加者不知情的试验,研究对象为221名年龄在3个月~17岁的儿童。将2011年3月—2012年1月在三级医疗机构儿科急诊因撕裂伤需要用组织粘合剂的患儿纳入研究。处理患儿伤口前,分别应用利多卡因-肾上腺素-丁卡因或安慰剂。使用彩色视觉疼痛模拟量表和面部表情疼痛量表-修订版,得出使用粘合剂时疼痛评分。同时请医生对伤口粘合和伤口止血的难度进行评分。结果视觉疼痛模拟量表(P=0.01)和面部表情疼痛量表-修订版评定结果表明〔止痛剂中位数0.00,四分位数间距(IQR)(0.00,2.00),与安慰剂中位数2.00,IQR(0.00,4.00),P<0.01〕,与使用安慰剂〔中位数1.00,IQR(0.38,2.50)〕相比,那些在伤口修复时用了止痛剂的患儿疼痛程度要轻〔中位数0.50,IQR(0.25,1.50)〕。用了止痛剂的患儿更倾向于报告自己接受了一次无痛修复过程〔疼痛相对危险度(RR)=0.54,95%CI(0.37,0.80)〕。与安慰剂组相比,使用利多卡因-肾上腺素-丁卡因的患儿,伤口得到完全止血的比例要多(78.2%与59.3%,P=0.008)。解释对于年龄在3个月~17岁的儿童轻度撕裂伤,在使用组织粘合剂修复伤口前用利多卡因-肾上腺素-丁卡因止痛,减少了疼痛评分,提升了无痛修复的比例。此低风险措施将使采用组织粘合剂而不是缝合治疗撕裂伤的儿童受益。
Background Some children feel pain when using a tissue adhesive to repair a wound. This study evaluated the effect of topical lidocaine-epinephrine-tetracaine analgesic pain relief and pain relief in the repair of wounds by tissue adhesives. METHODS: This randomized, placebo-controlled, participant-naïve trial of 221 children aged 3 months to 17 years. March 2011 - January 2012 in the tertiary medical institutions pediatric emergency because of laceration need to use tissue adhesive in children included in the study. Before treatment of a child’s wound, lidocaine-epinephrine-tetracaine or placebo was administered. Using the Color Vision Pain Scale and Facial Expression Pain Scale - Revised, the pain score was obtained using the adhesive. Ask the doctor to rate the difficulty of the wound and the wound to stop bleeding. Results The visual acuity analog scale (P = 0.01) and the facial expression pain scale (revised version) showed a statistically significant difference (median analgesic 0.00, interquartile range (IQR) 2.00, IQR (0.00, 4.00), P <0.01) compared with placebo [median 1.00, IQR (0.38, 2.50)] and those who used analgesics at wound repair required Light [median 0.50, IQR (0.25, 1.50)]. Children who used analgesics tended to report that they had undergone a painless repair procedure [relative risk of pain (RR) = 0.54, 95% CI (0.37, 0.80)]. Children who received lidocaine-epinephrine-tetracaine had far more complete hemostasis (78.2% vs 59.3%, P = 0.008) than placebo. Interpretation Mild laceration in children younger than 3 months to 17 years and pain relief with lidocaine-epinephrine-tetracaine prior to the wound repair using a tissue adhesive reduces pain scores and enhances painless healing proportion. This low-risk measure will benefit children who use tissue adhesives rather than suture to treat lacerations.