What are the recommended local anesthetic dose, suture material, and suturing technique for a 2-year-old child with a 3cm left supraciliary (above the eyebrow) laceration?

From the Guidelines

For a 2-year-old child with a 3cm left supraciliary laceration, I recommend using 1% lidocaine with epinephrine (1:100,000) at a maximum dose of 4-5 mg/kg (not to exceed 7 mg/kg total) as the local anesthetic dose. The anesthetic should be buffered with sodium bicarbonate (9:1 ratio) to reduce pain during injection and administered using a 30-gauge needle. For a typical 2-year-old weighing around 12-15 kg, this translates to approximately 5-7 mL maximum volume. The choice of local anesthetic is based on the guidelines provided by 1, which outlines the maximum safe doses for local anesthetic agents in children.

Suture Material Choice

• 6-0 fast-absorbing gut or 6-0 nylon (polypropylene) is recommended for this facial laceration, as it provides a good balance between cosmetic outcome and the child's limited tolerance for procedures.
• Alternatives to consider include other types of absorbable sutures, such as polyglactin 910 (VICRYL) or polyglyconate (Maxon), as discussed in 1.
• Non-absorbable sutures like nylon or polypropylene can also be used, but they require removal, which may be challenging in a child.

Suturing Technique

• A simple interrupted suturing technique is recommended, with sutures placed 2-3 mm apart.
• Alternatives to consider include a continuous suturing technique or a subcuticular suturing technique, depending on the specific needs of the wound and the child's skin type.
• The wound should first be thoroughly irrigated with normal saline and any foreign bodies removed, as outlined in general wound care principles. Consider topical anesthetics like LET (lidocaine-epinephrine-tetracaine) or EMLA cream applied 30 minutes before the procedure to minimize injection pain, as discussed in 1. Sutures should be removed in 5-7 days if non-absorbable material is used. This approach balances cosmetic outcome with the child's limited tolerance for procedures, while the epinephrine component helps with hemostasis and prolongs anesthetic effect without exceeding safe dosing for this age group.

From the Research

Recommended Local Anesthetic Dose

• For a 2-year-old child with a 3cm left supraciliary laceration, the recommended local anesthetic dose is not explicitly stated in the provided studies. However, studies 2, 3, and 4 suggest the use of topical anesthetics such as lidocaine, epinephrine, and tetracaine (LET) for laceration repair in children.
• The dose of LET is typically 4% lidocaine, 0.1% epinephrine, and 0.5% tetracaine, applied topically to the affected area 2.
• It is essential to note that the dose and application of local anesthetics should be determined by a qualified healthcare professional, taking into account the child's age, weight, and medical history.

Best Suture Material Choice and Alternatives

• The best suture material choice for a 2-year-old child with a 3cm left supraciliary laceration is not explicitly stated in the provided studies.
• However, study 5 suggests that absorbable sutures perform similarly to nonabsorbable sutures and do not require revisit for removal, making them a suitable option for pediatric patients.
• Alternatives to traditional sutures include novel atraumatic closure devices and tissue adhesives, which can provide painless and rapid closure of lacerations 5.

Best Suturing Technique and Alternatives

• The best suturing technique for a 2-year-old child with a 3cm left supraciliary laceration is not explicitly stated in the provided studies.
• However, study 5 mentions the use of tissue adhesives for wounds under tension, which can be an alternative to traditional suturing techniques.
• Other alternatives to traditional suturing techniques include the use of topical anesthetics and atraumatic closure devices, which can provide painless and rapid closure of lacerations 3, 5.