FIGURE 130.45 Image of J-Tip device (Reprinted with permission from National Medical Products, Inc.) Direct Wound Infiltration Immobilize the young child by wrapping him/her in a sheet, using a papoose restraint, or having an assistant restrain the child Use developmentally sensitive methods A calm, reassuring approach that engages the child in conversation or distraction may avoid the need for sedation Topical anesthetic should be applied first if time and wound location/size permits Cleanse the area well with antiseptic solution Dry with sterile gauze Instill a few drops of the anesthetic directly into the wound When anesthetizing a possible moving target, the operator should hold both sides of the wound with the nondominant hand The syringe containing lidocaine can be pressed firmly against the operator’s nondominant thumb This allows the patient, operator, and syringe to move in a unified fashion if the child struggles Begin injection proximally on the side of the wound closest to the spinal efferent nerve If the proximal portion of the wound is anesthetized first, then through blockage of nerve conduction, the distal portion may become partially anesthetized Injecting the anesthetic slowly can reduce pain caused by the rapid distension of tissues Insert a 25-, 27-, or 30-gauge needle through the subcutaneous tissue exposed by the laceration The subdermis of the wound is used because it is less painful than either direct injection through intact skin or into the dermis ( Fig 130.46A ) Slowly inject a small bolus of the lidocaine solution ( Fig 130.46B ) Continue to advance, aspirating prior to injecting if in the vicinity of large vessels Otherwise, aspiration before injection is rarely necessary Remove the needle and reinsert subcutaneously into adjacent tissue that has already been anesthetized Slowly inject another bolus of anesthetic and advance the needle while injecting ( Fig 130.46C )