Topical adrenaline and cocaine gel for anaesthetising children's lacerations. An audit of acceptability and safety.
OBJECTIVE
(1) To assess the acceptability of a gel solution of adrenaline (epinephrine) (1 in 2000) and cocaine (5%) for anaesthetising children's facial lacerations to the child, parent, and operator. (2) To assess the safety of the current protocol.


METHODS
The emergency unit of a large university hospital.


METHODS
All patients who were treated with topical adrenaline and cocaine (topAC) gel over a six month period were entered into a prospective audit (n = 75). Patient details, the nature and cause of the injury, and any treatment carried out were all recorded. The acceptability to children over 3 years of age, was assessed by the use of the Wong Baker face scale, in which 0 represents "no hurt" and 5 represents "hurts worst". The acceptability to both the parent and the operator was assessed by the use of a 0 to 9 Likert scale, where 0 represented "very acceptable" and 9 represented "not at all" acceptable.


RESULTS
(1) Children aged 3 years or older graded their pain during the procedure as having a mean value of 1.17 on the Wong Baker (0 to 5) scale. Parents graded acceptability on the Likert scale (0 to 9) with a mean score of 1.13. Operators using the same grading system, recorded a mean score of 1.75. (2) No toxic side effects were seen but the protocol was updated in line with evidence.


CONCLUSIONS
Topical adrenaline and cocaine is an effective anaesthetic for suturing children's facial lacerations and is acceptable to child, parent, and operator alike.
Maxillofacial Unit, University Hospital of Wales, Heath, Cardiff, UK. dwgkennedy@aol.com <dwgkennedy@aol.com>
D W G
DW
Kennedy
Z
Z
Shaikh
M J
MJ
Fardy
R J
RJ
Evans
StJ V
SV
Crean
D000287:Administration, Topical; D000293:Adolescent; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003042:Cocaine / Q000008:administration & dosage* / Q000009:adverse effects; D004338:Drug Combinations; D004837:Epinephrine / Q000008:administration & dosage* / Q000009:adverse effects; D005151:Facial Injuries / Q000601:surgery*; D005260:Female; D005782:Gels; D006801:Humans; D007223:Infant; D008297:Male; D008485:Medical Audit / Q000379:methods; D010146:Pain / Q000517:prevention & control; D010290:Parents / Q000523:psychology; D017060:Patient Satisfaction
D000779:Anesthetics, Local; D004338:Drug Combinations; D005782:Gels; D003042:Cocaine; D004837:Epinephrine