Search

Objective. To compare the effectiveness of four topical anesthetics that do not contain cocaine with that of topical tetracaine-adrenaline-cocaine (TAC) and lidocaine infiltration during laceration repair in children. Design. This was a randomized, blinded trial. Setting. The study was conducted in the emergency department of a large children's hospital. Participants. Subjects were children 2 years of age or older with a laceration 5 cm or less in length that required suturing. Interventions. Patients were randomly assigned to receive one of four noncocaine-containing topical anesthetics, topical TAC, or lidocaine infiltration anesthesia before laceration repair. Outcome Measures. Outcome measures assessed pain perceptions using a Visual Analogue Scale, Likert scale, and Anesthetic Effectiveness scale. Distress behaviors of patients were measured with the Restrained Infants and Children Distress Rating Scale. Results. Two hundred forty patients were enrolled in the study. Using α = 0.05 and β = 0.2, there was statistical power to detect differences of 0.3 to 1.3 U for the outcome measures used. The bupivacaine-norepinephrine topical solution (Bupivanor) performed better than the other three new topical preparations. It provided effective wound anesthesia during laceration repair, especially for lacerations of the face and scalp, where it was consistently rated as effective as TAC and 1% lidocaine infiltration by all observer groups for all outcome measures. There was a 4% overall wound complication rate, including one wound infection. Conclusion. Bupivanor is an effective alternative to TAC and lidocaine infiltration for local anesthesia during laceration repair, especially on the face and scalp. The effectiveness of Bupivanor on the face is important, because it is here where TAC is most likely inadvertently to come into contact with mucous membranes and result in systemic toxicity. Because pain and distress scores did not take into consideration the pain associated with the initial injection of lidocaine, the findings of this study conservatively estimate Bupivanor's effectiveness compared with lidocaine infiltration.

Study objective. The purpose of the present study is to compare LAT gel (4% lidocaine, 1:2000 adrenaline, 0.5% tetracaine) to TAC gel (0.5% tetracaine, 1:2000 adrenaline, 11.8% cocaine) for efficacy, side effects, and costs in children aged 5 to 17 years with facial or scalp lacerations. Design. Randomized, prospective, double-blinded clinical trial. Setting. Inner-city Emergency Department with an Emergency Medicine residency program. Patients or other participants. Children aged 5 to 17 years with linear lacerations of the face or scalp. Intervention. After informed consent was obtained patients had lacerations anesthetized with topical TAC or LAT gel according to a random numbers table. Measurements and main results. A total of 95 patients were included in the statistical analysis with 47 receiving TAC and 48 receiving LAT. Physicians and patients/parents separately rated the overall pain of suturing using a modified multidimensional scale for pain assessment specifically for children. Patients/parents also stated the number of sutures causing pain. The power of the study to determine a ranked sum difference of 15 was 0.8. Multidimensional rating scale results and number and percentage of sutures causing pain were compared using Wilcoxon's rank sum test. According to patients no difference could be detected in percent of sutures causing pain in the LAT versus TAC group (P = .51). Using the multidimensional scale, physicians and patients/parents found LAT statistically the same as TAC in effectiveness (P = .80 for physicians and P = .71 for patients). Cost per application was $3.00 for LAT compared to $35.00 for TAC. Follow-up was accomplished in 85 of 95 participants in the study with no reported complications for either medication. Conclusion. LAT gel worked as well as TAC gel for topical anesthesia in facial and scalp lacerations. Considering the advantages of a noncontrolled substance and less expense, LAT gel appears to be better suited than TAC gel for topical anesthesia in laceration repair in children.