Introduction of a LAT gel and low-dose midazolam sedo-analgesia protocol for pediatric skin suture in the emergency department: simpler is better.

Abstract

skin lacerations are one of the main causes of children's referral to the emergency department (ED). We introduced in our general ED a pediatric sedo-analgesia protocol (SAP) for suturing skin wounds using LAT gel, a local anesthetic solution of lidocaine, adrenaline and tetracaine, with or without low-dose oral midazolam according to patient's age, to improve the experience of laceration repair. Primary outcomes were improvement of suturing experience for ED operators (as a reduction in the desire to avoid the procedure) and of the adequacy of sedo-analgesia provided, investigated through two different surveys administered to the ED staff before and after the introduction of the SAP. Children's parents were asked about satisfaction with the sedo-analgesia provided. Data were collected prospectively. The analysis included 85 and 60 healthcare professionals involved in the suture of skin wounds in children, respectively before and after the introduction of our SAP. The introduction of the SAP reduced ED operators' stress and improved the entire suturing experience. The pre-post analysis showed a statistically significant improvement in the perceived adequacy of the provided sedo-analgesia (p < 0.0001) and a significant reduction of operators who would have avoided the procedure (p < 0.0001). The great majority of children's parents expressed a high level of satisfaction. The introduction of a LAT gel and low-dose oral midazolam SAP allows an improvement of both the sedo-analgesia provided and the ED operators' suturing experience of skin lacerations in children. Our SAP appeared to be safe and effective, with low cost and high tolerability.