Topical anesthetic cream vs. lidocaine infiltration for superficial laceration repair in the emergency department: a randomized clinical trial

BACKGROUND AND IMPORTANCE: Superficial skin lacerations requiring local anesthesia before suture are common in emergency departments (EDs). Lidocaine infiltration is effective but involves needle use, which may cause pain, discomfort, and increase patient anxiety. Topical anesthetic cream offers a needle-free alternative, yet comparative evidence in adult ED populations remains limited. OBJECTIVES: To compare the analgesic efficacy of topical anesthetic cream with lidocaine infiltration for anesthesia during the repair of superficial skin lacerations in adult ED patients. DESIGN: Randomized, open-label, superiority multicentric clinical trial. SETTINGS AND PARTICIPANTS: The study was conducted in two EDs in France. Adult patients presenting with a superficial laceration requiring suturing were eligible. INTERVENTION: Participants were randomized to receive either topical anesthetic cream applied before the procedure (a eutectic mixture of lidocaine 2.5% and prilocaine 2.5%) (intervention group) or standard lidocaine infiltration for local anesthesia (control group). OUTCOME MEASURES AND ANALYSIS: The primary outcome was the maximum pain experienced throughout the waiting, preparation, and suturing phases, measured using a Numeric Rating Scale (NRS: 0-10). Secondary endpoints were patient and provider satisfaction, rescue infiltrations, the patients' self-assessment of their maximum pain during each phase, ED length of stay, 15-day adverse effects, and wound healing. Analyses were conducted in the as-randomized population. MAIN RESULTS: Between December 2017 and 2021, a total of 126 patients were enrolled [mean age: 47 ± 23, 40 (31.7%) were women]. Among them, 62 (49.2%) were randomized to receive topical anesthetic cream, and 64 (50.8%) received lidocaine infiltration. The mean maximum NRS pain score was 4.63 (±2.3) in the topical anesthetic cream group and 4.25 (±2.5) in the lidocaine group, with a mean difference of 0.38 (95% confidence interval: -0.47 to 1.22), indicating no statistically significant difference. Patient tolerance and ED length of stay were comparable between groups. No meaningful differences were observed in 15-day wound-healing complications. CONCLUSION: Among patients with superficial lacerations requiring suturing in the ED, the application of topical anesthetic cream was not associated with a significant difference in pain relief compared with lidocaine infiltration.