Evidence‐based medicine.ppt

Evidence Based Medicine Victoria Pertubal, MD PGY-2 To LET or not to LET? Background LET or LAT = lidocaine + epinephrine/adrenaline + tetracaine Epinephrine / Adrenaline - potent vascontrictor, Addition of epinephrine in local anesthesia > prolongs the duration of action > decreases local bleeding during the procedure, > reduces systemic lidocaine absorption “ Digits can withstand prolonged periods of ischemia. essful reimplantations have been reported 42 hours after traumatic amputations ”. John L. Pfenninger, and Grant C. Fowler Pfenninger &Fowlers Procedures for Primary Care , Third Edition CHAPTER 5 , 25-27 ? 2011, 2003, 1994 by Mosby, Inc, PICO ? P opulation - finger laceration, children ? I ntervention / Exposure - Lidocaine + Epinephrine ? C omparison / standard therapy - lidocaine only ? O e - safety, effectiveness vs. harm digital necrosis Search for evidence: Search for evidence: Search for evidence: Literature Appraisal : Objectives : ? To determine the effectiveness of LAT in providing adequate anesthesia in repair of finger lacerations ? To monitor the risk of digital ischemia following application of LAT