Lidocaine adrenaline tetracaine gel versus tetracaine adrenaline cocaine gel for topical anesthesia in linear scalp and facial lacerations in children aged 5 to 17 years.
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.


METHODS
Randomized, prospective, double-blinded clinical trial.


METHODS
Inner-city Emergency Department with an Emergency Medicine residency program.


METHODS
Children aged 5 to 17 years with linear lacerations of the face or scalp.


METHODS
After informed consent was obtained patients had lacerations anesthetized with topical TAC or LAT gel according to a random numbers table.


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.


CONCLUSIONS
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.
Ernst
A A
AA
Department of Medicine, Louisiana State University, New Orleans.
Marvez
E
E
Nick
T G
TG
Chin
E
E
Wood
E
E
Gonzaba
W T
WT
D000293:Adolescent; D000772:Anesthesia, Local; D000779:Anesthetics, Local; D002648:Child; D002675:Child, Preschool; D003042:Cocaine; D004311:Double-Blind Method; D004338:Drug Combinations; D004632:Emergency Medical Services; D004837:Epinephrine; D005151:Facial Injuries / Q000601:surgery*; D005260:Female; D006801:Humans; D008012:Lidocaine; D008297:Male; D010147:Pain Measurement; D012535:Scalp / Q000293:injuries*; D013537:Sutures; D013748:Tetracaine; D014950:Wounds, Penetrating / Q000601:surgery*
D000779:Anesthetics, Local; D004338:Drug Combinations; D013748:Tetracaine; C034627:TEC solution; D008012:Lidocaine; D003042:Cocaine; D004837:Epinephrine