COMPARISON OF TOPICAL ANESTHETICS WITHOUT COCAINE TO TETRACAINE-ADRENALINE-COCAINE AND LIDOCAINE INFILTRATION DURING REPAIR OF LACERATIONS - BUPIVACAINE-NOREPINEPHRINE IS AN EFFECTIVE NEW TOPICAL ANESTHETIC AGENT

Objective. To compare the effectiveness of four topical anesthetics th at do not contain cocaine with that of topical tetracaine-adrenaline-c ocaine (TAG) and lidocaine infiltration during laceration repair in ch ildren. Design. This was a randomized, blinded trial. Setting. The stu dy was conducted in the emergency department of a large children's hos pital. Participants. Subjects were children 2 years of age or older wi th a laceration 5 cm or less in length that required suturing. Interve ntions. Patients were randomly assigned to receive one of four noncoca ine-containing topical anesthetics, topical TAG, or lidocaine infiltra tion anesthesia before laceration repair. Outcome Measures. Outcome me asures assessed pain perceptions using a Visual Analogue Scale, Likert scale, and Anesthetic Effectiveness scale. Distress behaviors of pati ents were measured with the Restrained Infants and Children Distress R ating Scale. Results. Two hundred forty patients were enrolled in the study. Using alpha = 0.05 and beta = 0.2, there was statistical power to detect differences of 0.3 to 1.3 U for the outcome measures used. T he bupivacaine-norepinephrine topical solution (Bupivanor) performed b etter than the other three new topical preparations. It provided effec tive wound anesthesia during laceration repair, especially for lacerat ions of the face and scalp, where it was consistently rated as effecti ve as TAC and 1% lidocaine infiltration by all observer groups for all outcome measures. There was a 4% overall wound complication rate, inc luding one wound infection. Conclusion. Bupivanor is an effective alte rnative to TAC and lidocaine infiltration for local anesthesia during laceration repair, especially on the face and scalp. The effectiveness of Bupivanor on the face is important, because it is here where TAC i s most likely inadvertently to come into contact with mucous membranes and result in Systemic toxicity. Because pain and distress stores did not take into consideration the pain associated with the initial inje ction of lidocaine, the findings of this study conservatively estimate Bupivanor's effectiveness compared with lidocaine infiltration.