From the Guidelines
2% lidocaine is not the preferred choice for sutures, as the recommended concentration is 1% lidocaine solution. When it comes to local anesthesia for suturing procedures, the goal is to provide effective pain control while minimizing potential risks. The standard formulation used is 1% lidocaine with epinephrine (typically 1:100,000), which provides effective pain control while performing sutures, as suggested by guidelines for the use of local anesthesia in office-based dermatologic surgery 1.
- Key points to consider when using local anesthesia for sutures include:
- The maximum safe dose of local infiltrated anesthesia is unknown, but for adults, no more than 4.5 mg/kg of lidocaine and 7.0 mg/kg of lidocaine with epinephrine should be administered in a single treatment 1.
- For a multistage procedure, a maximum dose of local infiltrative anesthesia of 50 mL of 1% lidocaine solution (500 mg) delivered over several hours is recommended 1.
- Use of either ester-type local anesthetics, bacteriostatic normal saline, or 1% diphenhydramine is suggested as an alternate form of local infiltration anesthesia for patients with true allergy to lidocaine 1.
- Lidocaine without epinephrine should be used for end arteriolar areas such as fingers, toes, nose, ears, and penis to avoid potential tissue ischemia.
- In terms of administration, the lidocaine should be injected into the subcutaneous tissue around the wound edges, waiting approximately 5-10 minutes for full effect before beginning to suture.
- It's also important to note that for patients with allergies to lidocaine or amide anesthetics, alternatives like bupivacaine or prilocaine may be used.
- Overall, the use of 1% lidocaine solution is recommended for local anesthesia during suturing procedures, as it provides effective pain control while minimizing potential risks, as supported by the guidelines for the use of local anesthesia in office-based dermatologic surgery 1.
From the Research
Local Anesthesia for Sutures
- The provided studies do not specifically recommend 2% lidocaine for sutures.
- A study from 2003 2 compared the effectiveness of 2% prilocaine, 1% lidocaine, and 1% buffered lidocaine in local anesthesia and pain reduction during injection in laceration repair, but it did not conclude that 2% lidocaine is the preferred choice.
- Another study from 1996 3 compared four injectable anesthetics, including buffered 1% lidocaine, but did not mention 2% lidocaine.
- A study from 1994 4 compared 1% lidocaine and 0.5% diphenhydramine for local anesthesia in minor laceration repair, and found that lidocaine was more effective for facial lacerations.
- Other studies 5, 6 discussed the use of different local anesthetics, such as mepivacaine and digital anesthesia, but did not provide information on the use of 2% lidocaine for sutures.
Comparison of Local Anesthetics
- The studies compared the effectiveness of different local anesthetics, including lidocaine, prilocaine, and diphenhydramine, but did not provide a clear recommendation for the use of 2% lidocaine for sutures.
- The choice of local anesthetic may depend on various factors, such as the location and type of laceration, patient characteristics, and the desired level of anesthesia.
- Further research is needed to determine the most effective local anesthetic for sutures.