LET versus EMLA for pretreating lacerations: a randomized trial

Acad Emerg Med. 2001 Mar;8(3):223-30. doi: 10.1111/j.1553-2712.2001.tb01297.x.


Objective: To compare the anesthetic efficacy of EMLA cream (eutectic mixture of local anesthetics) with that of LET solution (lidocaine, epinephrine, tetracaine) for pretreating lacerations prior to lidocaine injection.

Methods: This was a randomized, double-blind clinical trial in a convenience sample of 60 patients aged 1 to 59 years with traumatic lacerations. Eligible wounds were uncomplicated, clean lacerations < or = 6 hours old. Finger and toe lacerations were excluded. At the time of initial presentation to triage, patients were randomized to LET or EMLA. A nurse applied the topical anesthetic into the laceration with a 5-mL syringe. A physician assessed the laceration edges for the presence of blanching and adequacy of anesthesia to a 27-gauge needlestick. Supplemental lidocaine was then infiltrated through the wound edges and the pain of infiltration was recorded by the patient (or guardian) on a 100-mm visual analog scale marked "most pain" at the high end. A sample of 44 patients had 90% power to detect a 20-mm difference in injection pain (two-tailed alpha = 0.05).

Results: Sixty patients were randomized to LET (29) or EMLA (31). Median age was 8.5 years; 23% were female. Most lacerations were facial and closed with sutures. There was no difference in baseline characteristics between groups. More wounds treated with LET were anesthetic to a needlestick than wounds treated with EMLA (73% vs 40%, p = 0.01); however, there was no between-group difference in the median pain of lidocaine infiltration (LET-12 mm vs EMLA-13 mm, p = 0.89).

Conclusions: Pretreatment of simple lacerations with LET or EMLA at the time of patient presentation results in similar amounts of pain of subsequent local infiltration of lidocaine

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Anesthetics, Local / therapeutic use*
  • Child
  • Child, Preschool
  • Double-Blind Method
  • Female
  • Humans
  • Infant
  • Lacerations / therapy*
  • Lidocaine / therapeutic use*
  • Lidocaine, Prilocaine Drug Combination
  • Linear Energy Transfer / drug effects*
  • Male
  • Middle Aged
  • Ointments
  • Pain / etiology*
  • Pain Measurement
  • Prilocaine / therapeutic use*
  • Treatment Outcome
  • Wound Healing / drug effects
  • Wound Healing / radiation effects


  • Anesthetics, Local
  • Lidocaine, Prilocaine Drug Combination
  • Ointments
  • Prilocaine
  • Lidocaine