Before removing the head of a tick (usually left behind during an unsuccessful removal attempt by a parent), I apply topical LET (lidocaine, epinephrine, and tetracaine) gel. Then I wait 10 to 15 minutes, the same as I would before placing sutures. As the topical anesthetic works, the remaining portion of the tick often is pushed out of the skin. If that doesn't happen, I use a #11 surgical blade to gently scrape away the tick's remains. Even if I have to dig a bit to remove fragments of the tick, the topical anesthetic makes the process more comfortable for the child.
Mark Francis, MD
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