First Time for Everything
I did something the other day that I had never done before: I sutured a laceration without anesthetizing it first.
It was a 17-year-old boy messing around in the weight room who had been hit in the middle of the forehead, right at the hairline, with a barbell. There was no loss of consciousness, just a tiny little five millimeter laceration that was bleeding freely after being thoroughly cleaned out.
It only needed one stitch to close, and it occurred to me that the injections of lidocaine to numb it up would probably be at least as, if not more, painful than the single stitch with its two needle pokes. I explained this to the patient and his mother and he agreed to try. Of course I told him that if he changed his mind as I was doing it (ie, if it hurt too much) that I would stop and numb it up before continuing.
So I did it. The kid didn't blink; indeed, he said it didn't hurt nearly as much as he thought it would. Nothing to it. It was the first time I've ever documented in a chart,
After informed consent obtained, local anesthesia was deferred.I know there are tons of you ER types who routinely do this for tiny lacerations, but bear in mind I only sew up about a couple a year instead of dozens a month. For me, it was a first.