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Taking The Pain Out Of Laceration Repair At St. Clair Hospital

Emergency care for children is one of the most important parts of a doctor’s career. It’s also one of the most challenging. Why? Because an ER visit to have a laceration repaired is more than a common occurrence – it can be a traumatic experience.

Imagine it from the viewpoint of a child: you’re injured and bleeding, you’re in pain, and so you’re rushed to a hospital ER. You’re in an unfamiliar, bright, and intimidating environment. You have to get a shot – which you hate. Then a doctor approaches you with an odd-looking needle and thread, and a group of adults come in and hold you down, in order to make sure you stay still for suturing.

It’s a terrifying set of events; for many children the ER experience is far more distressing than the original injury, potentially leaving long-lasting psychological scars. So at St. Clair Hospital, we are taking steps to address one of the most frightening parts of an ER visit: pain.

 To help make children more comfortable during their hospital visit, St. Clair Hospital has now implemented an innovative and painless approach to the treatment of certain acute injuries in children. Safe, effective, and compassionate, the new method includes the use of nasal inhalation to administer medication that calms and quiets children so they can be treated. St. Clair emergency medicine physician Emily L. Brown, M.D., gives the method rave reviews.

“It can be terrifying for a child to be held down by adults,” notes Dr. Brown. “We’re pleased that we can now give a child a better experience. We use it primarily for treating lacerations and fractures and for imaging procedures, and we’ve had excellent results. Many times, it allows the child to lie still, and that makes it easier for the staff to complete the suturing.”

According to Dr. Brown, during the new procedure, “ER nurses apply topical Lidocaine, an anesthetizing agent, to the skin upon the child’s arrival. This numbs the area and eases any pain. Once it takes effect, we use a nasal atomizer to deliver a carefully calibrated dose of anti-anxiety medication into each nostril. The child is monitored throughout, with nurses keeping track of vital signs and oxygen saturation. After 10 minutes, the child is usually sufficiently calm. The effect lasts for 30–40 minutes and is well tolerated by the children.”

And this all adds up to a winning treatment combination, says Dr. Brown.

“No needles, no restraining, no IV, no pain — this is an ideal way to treat lacerations in children. For small and simple lacerations, instead of being sedated with IV medications or held down on a table, the child can quietly sit on a parent’s lap.”

Dr. Brown commends St. Clair’s Pharmacy Department, which worked closely with ER staff to develop the protocol and reformulate topical Lidocaine for this purpose, as well as Dr. Raymond D. Pitetti, associate chief of emergency medicine at Children’s Hospital of Pittsburgh of UPMC, an expert in pediatric sedation, who shared his knowledge and experience with the technique with St. Clair’s ER physicians.

“This is a wonderful service for the community; parents can count on being in-and-out of the ER quickly,” says Dr. Brown. “As an emergency medicine physician, and as a mother, I know the value of this new approach.”

Dr. Brown is board-certified in emergency medicine and serves as Vice Chair of Emergency Medicine at St. Clair Hospital.  She earned her medical degree at the University of Pittsburgh School of Medicine, and completed the Harvard-Affiliated Emergency Medicine Residency at Massachusetts General Hospital, and Brigham and Women’s Hospital in Boston, Massachusetts. She is employed by Emergency Resources Management, Inc.

St. Clair Hospital is constantly improving on the various healthcare services we offer to the community. To read more about our evolving care and find out what we’re doing for our patients today, we recommend browsing through our HouseCall publication. This story was originally printed in a recent issue, and is just one look into the work we do a daily basis.