Comparative efficacy and costs of various topical anesthetics for repair of dermal lacerations: a systematic review of randomized, controlled trials.
OBJECTIVE
To compare the efficacy of infiltrated local anesthesia with topical anesthesia for repair of dermal laceration, to analyze the efficacy of single or multicomponent topical anesthetics, and to identify topical formulations that are potentially less costly and equally efficacious as cocaine-containing topical anesthetics.


METHODS
Systematic review of randomized controlled trials.


METHODS
University-affiliated hospital.


METHODS
Pediatric and adult subjects.


RESULTS
Twenty-two trials that randomized more than 3000 patients were identified. The majority of studies demonstrated equivalent or superior analgesic efficacy for topical formulations compared with conventional intradermal infiltration. We found that cocaine is not a mandatory component of topical anesthesia. The literature discloses no significant difference in anesthetic efficacy between topical tetracaine-epinephrine-cocaine and each of the following 6 cocaine-free formulations: lidocaine-epinephrine-tetracaine, lidocaine-epinephrine, tetracaine-phenylephrine, tetracaine-lidocaine-phenylephrine, bupivicaine-norepinephrine, or prilocaine-phenylephrine.


CONCLUSIONS
Topical anesthetics are an efficacious, noninvasive means of providing analgesia before suturing of dermal lacerations. The use of cocaine-containing topical anesthetics can no longer be justified in light of its high cost and potential adverse effects. We have summarized the evidence, mostly favorable, supporting the use of various non-cocaine-containing topical anesthetics.
Eidelman
Anthony
A
Department of Anesthesiology and Pain Medicine, Caritas St. Elizabeth's Medical Center, Boston, MA 02135, USA.
Weiss
Jocelyn M
JM
Enu
Ikay K
IK
Lau
Joseph
J
Carr
Daniell B
DB
D000779:Anesthetics, Local / Q000494:pharmacology*; D003365:Costs and Cost Analysis; D062109:Dermatologic Surgical Procedures; D004837:Epinephrine / Q000494:pharmacology; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012867:Skin / Q000293:injuries*; D013536:Suture Techniques; D013748:Tetracaine / Q000494:pharmacology
D000779:Anesthetics, Local; D013748:Tetracaine; D004837:Epinephrine