Topical anaesthesia for children's lacerations: an acceptable approach?
OBJECTIVE
To compare the anaesthetic properties of conventional intradermal 1% plain lignocaine with a topical gel preparation of adrenaline (1:2000) and cocaine (4.7%) for use in treatment of children's lacerations.


METHODS
Children aged 3-16 years with lacerations (not of the digits or mucous membranes) were consecutively assigned to receive either adrenaline and cocaine (AC) or lignocaine. Pain scores, as perceived by patients, parents, and staff, were measured conventionally using Wong Baker faces and visual analogue scales on administration of the local anaesthetic and on suturing the wound in the AC group (n = 56) and the lignocaine group (n = 51).


RESULTS
Mean and median pain scores on administration of the anaesthetic in the AC group were significantly lower than in the lignocaine group as perceived by patient (P < 0.001), parent (P < 0.001), and staff (P < 0.001). There was no significant difference in mean and median pain scores between the two groups on suturing the wounds, as perceived by patient, parent and staff. There was a significantly higher number of "failed" anaesthetics (pain scores 8-10) in the lignocaine group (P < 0.01). On direct questioning the overall procedure was considered acceptable by 84.5% of parents in the AC group compared with 61% of parents in the lignocaine group (P < 0.01). There were no significant complications in either group.


CONCLUSIONS
Topical AC should be considered the local anaesthetic of first choice for suturing appropriate children's lacerations.
Kendall
J M
JM
Accident and Emergency Department, Frenchay Hospital, Bristol, United Kingdom.
Charters
A
A
McCabe
S E
SE
D000287:Administration, Topical; D000293:Adolescent; D000779:Anesthetics, Local / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003042:Cocaine / Q000008:administration & dosage; D004338:Drug Combinations; D004630:Emergencies; D004837:Epinephrine / Q000008:administration & dosage; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D010147:Pain Measurement; D011446:Prospective Studies; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D014947:Wounds and Injuries / Q000601:surgery*
D000779:Anesthetics, Local; D004338:Drug Combinations; D014662:Vasoconstrictor Agents; D008012:Lidocaine; D003042:Cocaine; D004837:Epinephrine