Anesthesia tips
Regardless of the age of the child, careful use of anesthesia is recommended. “I often have the parents apply a topical anesthetic at home for a few hours before their arrival,” said Bernard Cohen, MD, professor of dermatology, Johns Hopkins University, Baltimore. “I inject deeper in the subcutaneous fat first before injecting more superficially, and I try to extend the anesthetic from the first area of injection to minimize the pain.”
Johns Hopkins Medicine
Dr. Bernard Cohen
For his part, Dr. Sidbury recommends using EMLA or LMX cream, in advance of 1% lidocaine with buffered epinephrine injected locally. Topical EMLA works better if used liberally – albeit within specified safe limits, he said. So instead of applying a small amount and rubbing it in, a thicker layer can be applied without rubbing it in, and when possible, the area can be occluded with a dressing or other type of covering, “while you are waiting the 30-plus minutes for it to work.” Occluding the area with something like “Press ’N’ Seal” wrap that comes off easily, instead of adhesive, is a good idea, he added, since removing an adhesive dressing can be as painful as the procedure.
Like Dr. Cohen and Dr. Eichenfield, Dr. Sidbury also supports physical distraction when the lidocaine is injected, like “having the patient cough if the movement is not problematic. Or rubbing or scratching the adjacent skin to the site of shot, or the opposite arm.”
Dr. Eichenfield, Dr. Sidbury, and Dr. Cohen reported no relevant disclosures.