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Three new topical anesthetics that do not contain cocaine may be as effective, and possibly safer, than the commonly used tetracaine-adrenaline-cocaine (TAC) preparation. A total of 240 children requiring sutures received a new anesthetic or TAC. Pain during stitching was scored by three observer groups and the patient, if over four years of age. Two additional scoring scales were used by the observers, and one group completed a third. All of the new agents performed well, with one, tetraphen, consistently showing no statistical difference in any of the rating methods, as compared to TAC., ABSTRACT. Objective. To compare the effectiveness of three new topical anesthetics that do not contain cocaine (prilocaine-phenylephrine, tetracaine-phenylephrine [tetraphen], and tetracaine-lidocaine-phenylephrine) to that of tracaine-adrenaline-cocaine (TAC) during laceration repair in children. Design. Prospective, randomized, double-blind clinical trial. Setting. The emergency department of an urban children&apos;s hospital. Participants. Children 1 year of age or older with a laceration [is less than or equal to] 5 cm in length that required suturing. Intervention. A total of 240 children were randomly assigned to one of four treatment groups. Outcome Measures. Pain felt during suturing was scored by suture technicians, research assistants, parents, and patients [is greater than or equal to] 5 years of age using a visual analogue scale (VAS). Suture technicians, research assistants, and parents also scored pain using a seven-point Likert scale. In addition, suture technicians completed an anesthetic effectiveness scale. Results. There was consistently no difference demonstrated between the effectiveness of tetraphen and that of TAC for each outcome measure of each observer group. A statistically significant difference was seen among anesthetics when comparing VAS and Likert scale scores of suture technicians and Likert scale scores of research assistants. Based on post hoc analyses, these statistically significant differences were between TAC and prilocaine-phenylephrine (suture technician VAS and Likert scale) and between TAC and tetracaine-lidocaine-phenylephrine (suture technician Likert scale), but not between TAC and tetraphen. When power analyses were performed using [alpha] = 0.05 and [beta] = 0.20, it was possible to detect a difference of 1.2 VAS units for each of the observer groups. Based on anesthetic effectiveness scale scores, the three new topical preparations collectively performed significantly better on the face and scalp than on the extremities (relative risk = 1.83; 95% confidence interval 1.20 < relative risk < 2.79). Conclusion. This study demonstrated the effectiveness and safety of three new non-cocaine-containing topical anesthetics. Consistently, there was no statistical difference demonstrated between the effectiveness of tetraphen and that of TAC for each outcome measure of each observer group. Tetraphen offers an effective alternative to TAC during laceration repair in children., Pediatrics 1997; 100:825-830; prilocaine, tetracaine, lidocaine, TAC, topical anesthesia, laceration, pediatric emergency department ABBREVIATIONS. TAC, tetracaine--adrenaline--cocaine; Prilophen, prilocaine--phenylephrine; Tetraphen, tetracaine--phenylephrine; Tetralidophen, tetracaine--lidocaine--phenylephrine; VAS, visual analogue scale; RR, relative risk. Use [...]

Bupivacaine-norepinephrine may be an effective topical anesthetic. This gives it an advantage over the other topical anesthetic widely used in children, a mixture of tetracaine, adrenaline, and cocaine (TAC), because if cocaine is misapplied and absorbed, it is highly toxic. Researchers randomly assigned 240 children aged 2 to 17 who needed cuts stitched to one of six groups: bupivacaine-norepinephrine, etidocaine-norepinephrine, mepivacaine-norepinephrine, prilocaine-norepinephrine, TAC, or locally injected lidocaine. Blanching of the wound indicates effective anesthesia. Blanching was judged extensive in 58% of children receiving TAC, 37% of children receiving bupivacaine, 33% of children receiving prilocaine, 23% of patients receiving mepivacaine, and 21% of patients receiving etidocaine. Pain scores as assessed by researchers, suture technicians, parents, and children over age five rated local injection, TAC, and bupivacaine similarly. The rating of the local injection did not take into account the pain of the injection itself., 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&apos;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 [alpha] = 0.05 and [beta] = 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&apos;s effectiveness compared with lidocaine infiltration. Pediatrics 1996;97:301-307; bupivacaine, lidocaine, TAC, topical anesthesia, anesthetic, local, laceration, suture techniques, pain, emergency department., Use of topical anesthesia for repair of dermal lacerations in children offers many advantages. The tissue distortion that occurs with infiltration anesthesia is avoided. Anesthesia without a painful injection is [...]