Anaesthesia - Topical wound


These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline. 

Read the full PCH Emergency Department disclaimer.


To guide staff in the use of Laceraine® as a topical anaesthetic in wounds. Laceraine Gel® is the preparation available in PCH Emergency Department (ED).

Key Points

  • Topical anaesthetics in Laceraine® are useful for children with wounds requiring suturing or debridement.
  • Vasoconstriction from adrenaline in Laceraine® can be useful for oozing wounds prior to closure with tissue glue.
  • Laceraine Gel® is only to be used in PCH ED. It is not for ward use.



Sterile wound anaesthetic gel: 4mL
  • Adrenaline (epinephrine) 0.18% w/v (1.8mg/mL).
  • Lidocaine (lignocaine) hydrochloride 4% w/v (40mg/mL).
  • Tetracaine (amethocaine) hydrochloride 0.5% w/v (5mg/mL).
Onset: 20-30 minutes
Duration: 45-60 minutes following removal of the gel.


  • Topical use on broken skin.
  • Local anaesthesia for wound management (cleaning, closure).
  • Haemostasis.

Contraindications 1,2

  • Children < 1 year
  • Do not use on digits, pinnae, tip of nose, penis, or other end arterial areas, don’t rub in with fingers or allow patients to do so
  • Not for dental use or where entry into major blood vessels may occur.
  • Not meant for use on intact skin - consider EMLA® or Numit®.
  • Do not apply to mucous membranes, prevent the child from rubbing the area as they may transfer to these areas.
  • Do not use on wounds >7 cm, bites, contaminated or complex wounds, burns, extensive abrasions.
  • Do not use in patients with hypersensitivity to any local anaesthetic.
  • Do not use on bites - animal or human2
  • An increased risk of arrhythmias may occur in patients under therapy with cardiac glycosides, quinidine or tricyclic antidepressants.
  • When a patient has been treated with monoamine oxidase inhibitors, they should not be treated with Laceraine® gel topical wound anaesthetic until at least 14 days after treatment has ceased.

Adverse reactions

  • Systemic toxicity is rare and invokes mainly central nervous system (CNS) (usually first) and cardiovascular system (CNS): restlessness, dizziness, tinnitus, nausea and vomiting, tremors, convulsions, CNS depression.
  • Numbness of the tongue and perioral region may be an indicator of early systemic toxicity.
  • Cardiac effects are myocardial depression and vasodilation.
  • Contains sulphites (as sodium metabisulfate), may cause allergy in susceptible patients2

Dosage preparation2

  • Use a syringe and draw up the required amount from the 4mL vial.
  • Dose:
    • 1-3 years: 0.1mL/kg (maximum dose 2mL)
    • >3 years: 0.1mL/kg (maximum dose 3mL)
    • Note 0.1mL/kg = 4mg/kg of lidocaine.
  • Maximum 4 doses of Laceraine® over 24 hours1.
  • For use in one patient on one occasion only and discard any unused gel.


  • Clean wound, removing debris and clotted blood.
  • Wearing gloves.
    • Directly apply the gel onto the wound and wound margins
    • A cotton-tipped applicator can be used
    • Cover with an occlusive dressing (Tegaderm™ / Opsite ™). Use of gauze or island wound dressings is not recommended.
    • If applying on the scalp, cotton balls and a crepe bandage maybe required
  • Advise child / carer:
    • May sting on first application.
    • Not to interfere with site.
  • Leave for 20-30 minutes (maximum 60 minutes)
    • Remove the occlusive dressing and clean or irrigate the wound of residual gel.
    • Test sensation prior to further treatment.
    • Blanching at edges is usual.
  • Supplemental 1% lidocaine can be used intradermally as long as a total lidocaine does not exceed 5mg/kg
  • Maximum additional lidocaine dose 1mg/kg = 0.1mL/kg of 1% lidocaine.


  1. AMH Children’s Dosing Companion, Australian Medicines Handbook Pty Ltd,  [Internet] July 2021; Lidocaine, Tetracaine and Adrenaline
  2. Laceraine® Gel Topical Wound Anaesthetic – Australian Product Information Version 2 Phebra August 2020
  3. Hsu D. Clinical use of topical anaesthetics in children - UpToDate Mar 2020, Cited 7 December 2021. Available from: Clinical use of topical anaesthetics in children - UpToDate ( (

Endorsed by: Drugs and Therapeutics Committee  Date:  Nov 2021

 Review date:   Nov 2024

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