Laceration Clinical Pathway — Emergency Department

Analgesia, Local Anesthesia, Anxiolysis and Sedation

  • Child Life for pre-procedural teaching and support
  • Consider options for anxiolysis and regional pain control preferentially over sedation

Analgesia

Medication/Route Dose Additional Information
Acetaminophen PO 15 mg/kg/dose Max: 650 mg
Ibuprofen PO 10 mg/kg/dose Max: 600 mg
Oxycodone PO 0.2 mg/kg/dose Age < 6 yrs, Max: 2.5 mg
Age 6-12 yrs, Max: 5 mg
Age > 12 yrs, Max: 10 mg
Fentanyl IN 1-2 mcg/kg/dose Max: 100 mcg
Morphine IV 0.05-0.1 mg/kg/dose Max: 4 mg
Fentanyl IV 1 mcg/kg/dose Max: 50 mcg

Local Anesthesia and Regional Pain Control

Medication/Route Dose Additional Information
Topical LET Gel, Topical
  • Children < 24 kg use 0.125 mL/kg
  • Children > 24 kg use entire 3 mLs
  • Lidocaine 4%, epinephrine 0.1%, tetracaine 0.5% (3 mL)
  • Max: 0.125 mL/kg
Lidocaine 1%, Intradermal
Use 25 or 27-gauge needle,
inject slowly
 Varies with procedure, degree of anesthesia needed, vascularity of tissue, duration of anesthesia required
  • Max: 0.45 mL/kg
  • Equivalent to 4.5 mg/kg/dose
  • Not to exceed adult dose of 300 mg
Lidocaine 1% Buffered, Intradermal
Use 25 or 27-gauge needle,
inject slowly
  • Lidocaine 1% and sodium bicarbonate 9:1
  • Duration: 30 min to 1 hr
Lidocaine 1% with Epinephrine, Intradermal
Use 25 or 27-gauge needle,
inject slowly
  • Max: 0.7 mL/kg/dose equivalent to 7 mg/kg/dose
  • Not to exceed adult dose of 500 mg (equivalent to 50 mL of lidocaine 1%)
  • Duration: 2 hrs
Lidocaine 1%, Nerve Block Volume determined by site
  • Max: 0.45 mL/kg
  • See images below of:
    • Finger space web block (traditional digital block)
    • Transthecal block (flexor tendon sheath digital block)

Technique for Regional Pain Control

Finger Web Space Block
Traditional digital block		 Transthecal Block
Flexor tendon sheath digital block

For anxiolysis and IV sedation options, see Procedural Sedation ED Pathway.