LAT Gel Guideline 1

Emergency Department Addenbrooke’s Hospital
Surgical Directorate
Guideline
Use of LAT gel
Reason for development
• To standardise/improve patient care.
1 Scope
Children with wounds requiring suturing
2 Aim
This guideline is to help the clinician treating a child with a wound that requires
suturing
Ingredients
Lidocaine 4%, Adrenaline 0.1%, Tetracaine 0.5% (LAT)
Background
• Skin lacerations requiring cleaning and suturing are commonly seen in children
presenting to the ED. Neither of the standard topical anaesthetic agents
[Emla® (lidocaine, prilocaine) and Ametop® (tetracaine)] can be applied to
open wounds as they do not contain a vasoconstricting agent and so rapid
absorption may result in systemic toxicity.
• The alternative of injection of local anaesthesia (e.g. lidocaine) has a major
disadvantage of fear associated with injection among children who may require
sedation before a procedure can take place. Also injection of local anaesthetic
can lead to tissue distortion.
• LAT gel is a topical anaesthetic gel that can be applied to open wounds.
• LAT gel reduces the need to inject local anaesthetic/sedation when cleaning and
suturing open wounds in paediatric patients.
Eligibility
Cambridge University Hospitals NHS Foundation Trust Page 1 of 4
LAT gel for paediatric wounds Guideline

• Simple lacerations of the head, neck, limbs, or trunk

• Wounds less than 5cm in length
Contraindications
• Allergy to amide anaesthetics
• Gross contamination of wound
• Involvement of mucous membranes, digits, genitalia, ear, or nose
Adverse Events2,3,5
• Local irritation may occur in some patients.
• Effect of local anaesthetic and vasoconstrictor reduce potential for systemic
absorption and hence adverse effects.
Cautions for use

• Previous adverse effect
• Allergy to any of the product ingredients
Dosage and Application Procedure6

• LAT should be applied according to standard ED topical anaesthetic gel
procedure;
• Application should be performed at initial nurse assessment or as soon after as
is possible.
• Time of application should be documented on the initial assessment sheet.
• Dosage is 0.5ml to 1.0ml per cm of wound length up to a maximum of:
2ml for those aged 1-3 years
3ml for those over 3 years
Maximum wound length: 5 cm
• Place half of dose of LAT gel onto open wound and cover with occlusive dressing
(e.g. sterile gauze) onto which the remaining half has been applied.
• Press firmly over the dressing for 30 minutes either with tape or the parent's
gloved hand.
• After removing the gauze, test the effectiveness of the anaesthesia by touching
with a sterile needle.
• Wound cleaning and suturing should be completed within 15 minutes of removal
of the gel.
• Each bottle is for use on one patient only, and should be discarded within 24
hours of opening.

References
1. Torbay Hospital Pharmacy Specials Manufacturing Unit
2. Ernst AA et.al. Lidocaine Adrenaline Tetracaine (LAT Gel) versus injectable

buffered Lidocaine for local anesthesia in laceration repair. West J Med 1997;
167 (2); 79-81
3. Schilling CG et.al. Tetracaine, epinephrine (adrenaline) and cocaine (TAC)

versus Lidocaine, epinephrine (adrenaline), tetracaine (LET) for anesthesia of
lacerations in children. Annals of Emergency Med. 1995; 25(2): 203-8
4. Ferguson C; Loryman B. Topical anaesthetic versus lidocaine infiltration to allow

closure of skin wounds in children. Best Evidence Topics. Accessed via
www.bestbets.org 09/08/05.
5. Ferguson C; Loryman B. Topical anaesthetic versus lidocaine infiltration to allow

closure of skin wounds in children. Emergency Medicine Journal. 2005; 22:
507-509.
6. Resch K, Schilling C, Borchert BD, et al. Topical Anesthesia for Pediatric

Lacerations: A Randomized Trial of Lidocaine-Epinephrine-Tetracaine Solution
Versus Gel. Annals of Emergency Medicine. 1998; 32, 693-697
Equality and Diversity Statement

This document complies with the Cambridge University Hospitals NHS
Foundation Trust service Equality and Diversity statement.
Disclaimer
It is your responsibility to check against the electronic library that this printed
out copy is the most recent issue of this document.

Document management
Document ratification and history

Approved by: Sue Robinson
Date approved: 20/04/2006
Date placed on electronic May 2006
library:
Submitted for ratification by: Clinical and Corporate Governance Committee
Date: May 2006

Review date: April 2008 (or earlier in the light of new evidence)
Obsolete date: July 2008
Authors: Paul Atkinson
Owning Department: Emergency department
File name: LAT Gel Guideline
Version number:
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Emergency Department Addenbrooke’s Hospital

Use of LAT gel

Reason for development

• To standardise/improve patient care.

Cambridge University Hospitals NHS Foundation Trust Page 1 of 4

LAT gel for paediatric wounds Guideline

• Simple lacerations of the head, neck, limbs, or trunk

Cautions for use

Dosage and Application Procedure6

Cambridge University Hospitals NHS Foundation Trust Page 2 of 4

LAT gel for paediatric wounds Guideline

2. Ernst AA et.al. Lidocaine Adrenaline Tetracaine (LAT Gel) versus injectable

3. Schilling CG et.al. Tetracaine, epinephrine (adrenaline) and cocaine (TAC)

4. Ferguson C; Loryman B. Topical anaesthetic versus lidocaine infiltration to allow

5. Ferguson C; Loryman B. Topical anaesthetic versus lidocaine infiltration to allow

6. Resch K, Schilling C, Borchert BD, et al. Topical Anesthesia for Pediatric

Equality and Diversity Statement

Cambridge University Hospitals NHS Foundation Trust Page 3 of 4

LAT gel for paediatric wounds Guideline

Document ratification and history

Date: May 2006

Cambridge University Hospitals NHS Foundation Trust Page 4 of 4

LAT gel for paediatric wounds Guideline

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