Giving local anaesthetic before closing a wound

Do not use local anaesthetic + adrenaline (epinephrine) for fingers, toes, penis
2–5mL of lidocaine (lignocaine) 1% usually needed for most procedures

Maximum safe dose is 3mg/kg up to 200mg OR medical consult for higher dose
Lidocaine (lignocaine) 1% is 10mg/mL

If wound bleeding use lidocaine (lignocaine) 1% + adrenaline (epinephrine) 1:100,000
Topical anaesthetic (skin) patches

Do not leave on for more than one hour — anaesthetic may be absorbed and cause symptoms such as dizziness, headache, fast pulse, cyanosis (blue skin), especially in children

Before injecting, always pull back on (withdraw) syringe plunger to make sure you are not in vein/artery
To lessen pain

LA can be injected as needle pulled back out through tissue. Will anaesthetise all tissue in its path

If needle pulled out steadily and continuously — LA should not be injected into vein or artery — practice on a piece of meat

‘Fanning’ — technique used to inject wide area of tissue from single injection point

Needle put in at one spot then moved around in clockwise or anti-clockwise direction to anaesthetise a bigger area (eg sural (foot) nerve block, episiotomy)

Check area for feeling using sharp needle. Also gives person confidence
Ask person to feel around their own wound to give them confidence that local anaesthetic is working

Try flushing wound with small amount of LA before first injection. Wait 2–3 minutes for this to work
Do not go too deep with injection. Anaesthesia may be delayed or not work at all
Aim to put needle below dermal layer of skin and above fat layer
If needle in dermal layer — will be hard to press down syringe plunger. Take it out, try again a little deeper
Scalp wounds may need bigger needle to infiltrate — tissue is tough

See Examining and cleaning a wound before closing
Put bluey under site
Lay out dressing pack, equipment
Wash hands, put on sterile gloves
Clean site, drape with sterile towels
Draw up LA
Starting at one end of wound, slide needle through wound edge under dermal layer and above fat — Figure 7.26, needle a

Pull back on plunger to check for vein/artery, then inject anaesthetic as you pull needle out. Will anaesthetise shaded area around A — Figure 7.26
Wait a few moments until anaesthetic is working, so person doesn't feel it, then push needle into anaesthetised area at tip of previous injection — Figure 7.26, needle b. Repeat injection as above
Keep doing this until wound is anaesthetised along its whole length, then repeat process on other side — Figure 7.26, needle c and needle d
If wound short — may only need 1 injection on each side

Make sure ends of wounds also injected with LA
Wait for anaesthetic to work. Use needle to test for feeling before you start suturing

Figure 7.26

More painful than direct infiltration. Only use if wound very dirty and needle may take dirt further into tissue

See Examining and cleaning a wound before closing
Put bluey under site
Wash hands, put on sterile gloves
Lay out dressing pack, equipment
Clean site, drape with sterile towels
Draw up LA
Starting at one end of wound about 4mm from edge, push needle in, keeping parallel to wound edge — Figure 7.27, needle a

Pull back on plunger to check you are not in vein/artery, then inject anaesthetic as you pull needle out
Wait a few moments, push needle into anaesthetised area at tip of previous injection, inject as before — Figure 7.27, needle b
Keep doing this until wound anaesthetised along its whole length, then repeat process on other side — Figure 7.27, needle c and needle d
If wound short — may only need 1 injection on each side

Make sure ends of wounds also injected with LA
Wait for anaesthetic to work. Use needle to test for feeling before you start suturing

Figure 7.27