title: Prilocaine-phenylephrine and bupivacaine-phenylephrine topical anesthetics compared with tetracaine-adrenaline-cocaine during repair of lacerations.
abstract: The effectiveness of two new topical anesthetics that do not contain cocaine (prilocaine-phenylephrine and bupivacaine-phenylephrine) was compared with that of tetracaine-adrenaline-cocaine (TAC) during laceration repair in children. This study was a prospective, randomized, double-blind trial conducted in the emergency department of a large children's hospital. Participants were 180 children 1 year of age or older with a laceration 5 cm or less in length that required suturing. Pain felt during suturing was scored by suture technicians, research assistants, parents, and patients 5 years of age and older using a visual analogue scale (VAS). There was no statistical difference demonstrated between the effectiveness of prilocaine-phenylephrine and that of TAC for any of the observer groups. A statistically significant difference was seen among anesthetics when comparing VAS scores of research assistants (P = .002), suture technicians (P = .006), and parents (P = .03), but not when comparing VAS ratings of patients (P = .07). Based on Tukey's post hoc test, these statistically significant differences were between TAC and bupivacaine-phenylephrine. When power analyses were performed using alpha = 0.05 and beta = 0.20, it was possible to detect a difference of 1.3 VAS units for each rater group. In conclusion, this study demonstrated the effectiveness and safety of prilocaine-phenylephrine and bupivacaine-phenylephrine. Prilocaine-phenylephrine statistically outperformed bupivacaine-phenylephrine and offers an effective alternative to TAC during laceration repair in children.
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, USA.
authors.forename: G A
authors.initials: GA
authors.lastname: Smith
authors.forename: S D
authors.initials: SD
authors.lastname: Strausbaugh
authors.forename: C
authors.initials: C
authors.lastname: Harbeck-Weber
authors.forename: D M
authors.initials: DM
authors.lastname: Cohen
authors.forename: B J
authors.initials: BJ
authors.lastname: Shields
authors.forename: J D
authors.initials: JD
authors.lastname: Powers
authors.forename: T
authors.initials: T
authors.lastname: Barrett
mesh_terms: D000293:Adolescent; D000772:Anesthesia, Local; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003042:Cocaine / Q000008:administration & dosage*; D062109:Dermatologic Surgical Procedures; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D010146:Pain / Q000517:prevention & control; D010147:Pain Measurement; D010656:Phenylephrine / Q000008:administration & dosage*; D011318:Prilocaine / Q000008:administration & dosage*; D011446:Prospective Studies; D012449:Safety; D012867:Skin / Q000293:injuries*; D013536:Suture Techniques; D013748:Tetracaine / Q000008:administration & dosage*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
chemical_list: D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D011318:Prilocaine; D013748:Tetracaine; D010656:Phenylephrine; D003042:Cocaine; D002045:Bupivacaine; D004837:Epinephrine