Suturing Small Finger Lacerations in Pediatric Patients

Pain Management

For optimal outcomes when suturing a small finger laceration in a pediatric patient, begin with topical anesthesia followed by local infiltration if needed, and use absorbable sutures to avoid the pain and anxiety of suture removal, as recommended by the American Academy of Pediatrics 1
Apply LET (lidocaine, epinephrine, and tetracaine) to the wound and cover with an occlusive dressing or place a cotton ball soaked with LET solution into the wound, allowing it to soak for 10-20 minutes or until wound edges appear blanched 1
Inject lidocaine in an almost painless manner by buffering the anesthetic with bicarbonate, warming the lidocaine before injection, and injecting slowly with a small-gauge needle 1
Warming the lidocaine before injection can also help reduce pain, according to the American Academy of Pediatrics 2

Perform hand hygiene with antimicrobial soap or alcohol-based hand rub before touching the wound, as recommended by the American Academy of Pediatrics 3
Use sterile technique including sterile gloves, gown, equipment, and sterile towels, and clean the area with betadine or chlorhexidine over a large area of skin, as recommended by the American Thoracic Society 4

Consider using absorbable sutures to avoid the pain and anxiety of suture removal, especially in pediatric patients, as recommended by the American Academy of Pediatrics 1

Consider using tissue adhesives (such as octyl cyanoacrylate) for low-tension wounds as they provide essentially painless closure, as recommended by the American Academy of Pediatrics 1
Steri-Strips may provide similar painless closure and are less expensive than tissue adhesives, according to the American Academy of Pediatrics 1
For children who are anxious or uncooperative, consider distraction techniques and guided imagery, as recommended by the American Academy of Pediatrics 5
Age-appropriate games or videos on electronic devices can also help reduce anxiety in pediatric patients, according to the American Academy of Pediatrics 5

Maintain sterile technique throughout the procedure, as recommended by the American Academy of Pediatrics 3
Consider prophylactic antibiotics only if the wound is heavily contaminated or involves high-risk structures, according to the American Academy of Pediatrics 2

Provide clear instructions to parents about wound care, including keeping the wound clean and dry for 24-48 hours, watching for signs of infection, and using pain control measures such as acetaminophen, ibuprofen, and ice packs, as recommended by the American Academy of Pediatrics 2
Schedule follow-up if needed, particularly for wounds at high risk of infection or complications, according to the American Academy of Pediatrics 2

Never use substantial force when injecting local anesthesia as this increases pain, as recommended by the American Thoracic Society 4
Do not use petroleum-based hand lotions before donning gloves as petroleum can deteriorate latex material, as recommended by the American Academy of Pediatrics 3
Remember that children under 6 years of age (particularly those under 6 months) may be at greatest risk of adverse events during procedures requiring sedation, according to the American Academy of Pediatrics 5