Topical Agents

Topical agents (agents applied on top of the surrounding skin and absorbed
into the area to provide anesthesia without injections) are now
available. However, they are quite expensive and can be used only on
the surface, not deep within an open wound. They can be quite effective
for performing simple excisions or starting intravenous lines.
Although topical agents may become important in the future, because
of their expense and limited usefulness, they are not discussed further
in this chapter.

Application of cold works for only a few minutes but may allow
enough time to place one or two stitches. Cold also may help by decreasing
the pain of local anesthetic injection. It can be especially useful
in children. Have the patient hold ice over the area for 5 minutes before
injection. Another way to apply cold is to spray the area with ethyl
chloride solution.