Paediatric Acute care Guidelines PMH Emergency Department
Description 

ALA (Laceraine): Sterile wound anaesthetic: 5 ml vial

  • Adrenaline 0.1%w/v (1:1000 or 1 mg/ml)
  • Lignocaine HCL 4% M/V (40 mg/mL)
  • Tetracaine (Amethocaine) 0.5% (5mg/mL)
  • Onset: 20-30 minutes
  • Duration: 30-60 minutes
Indications
  • Topical use on broken skin
  • Local anaesthesia for wound management (cleaning, closure) 
  • Haemostasis
Contraindications
  • Do not use on digits, pinnae, tip of nose, penis or other end arterial areas
  • Not for dental use or where entry into major vessels may occur
  • Not meant for use on intact skin – consider EMLA®
  • Do not apply to mucous membranes
  • Do not use on wounds > 7 cm, bites, contaminated or complex wounds, burns, extensive abrasions
  • Do not use in patients with hypersensitivity to any local anaesthetic
Adverse Reactions
  • Systemic toxicity is rare and invokes mainly CNS (usually first) and CVS: restlessness, dizziness, tinnitus, nausea and vomiting, tremors, convulsions, later depression. 
  • Numbness of the tongue and perioral region may be an indicator of early systemic toxicity.
  • Cardiac effects are myocardial depression and vasodilation. 
Dosage / Preparation
  • Use a syringe: Draw up 0.1 mL/kg (maximum of 3mL) from the 5ml vial
    • 0.1mL/kg  = 4mg/kg of lignocaine
Administration
  • Clean wound removing debris and clotted blood
  • Wearing gloves
    • Soak cotton wool ball/s with the ALA and apply to wound
    • Cover cotton balls and area around wound with Tegaderm™/Opsite  
  • Advise child/carer
    • May sting on first application
    • Not to interfere with site
  • Leave for 20-30 minutes (maximum 60 minutes)
    • Test sensation prior to further treatment
    • Blanching at edges is usual
  • Supplemental 1% lignocaine can be used intradermally as long as a total lignocaine dose does not exceed 5mg/kg
    • Maximum additional lignocaine dose 1mg/kg = 0.1mL/kg of 1% lignocaine  

References

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