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Letter to the Editor

Letter to the Editor

Evidence that Cotton Ball Works Better?

doi: 10.1097/01.EEM.0000669400.45518.55


    I read Dr. Michelle Lin's Post-It Pearl on using a cotton ball v. gauze for LET application. (“A Cotton Ball, Not Gauze, for Topical Anesthetics,” EMN. 2020;42[3]:14; I have used both. I believe that gauze cannot wick away the LET as long as it is 2 x 2 and soaked with enough liquid. A cotton ball is fine for a smaller laceration, but may be too small for some lacerations. Does Dr. Lin have any evidence that cotton balls work better?

    I usually combine the LET with a 2% xylocaine mucosal gel. I have no evidence for this, but perhaps Dr. Lin is familiar with this topical combination?

    Barry Ehrlich, MD

    Newton, MA

    Dr. Lin responds: Thank you for the feedback and question. You are exactly correct that there is no magic to cotton balls over gauze except that they are less absorbent. Your key phrase is “soaked with enough liquid.” At least at my institution, the LET solution comes in only 2-3 mL aliquots, and it would likely require two or three vials to saturate a 2 x 2 or 4 x 4 gauze enough to achieve the same effect as a cotton ball in my experience. I haven't heard of the combination formulation of LET and a 2% xylocaine mucosal gel, but it sounds reasonable to create a more viscous topical anesthetic slurry.

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