EFFICACY OF TOPICAL ANESTHESIA IN CHILDREN

Objectives: To compare the efficacy of three formulations of a topical anesthetic solution composed of various concentrations of tetracaine hydrochloride, adrenaline (epinephrine), and cocaine hydrochloride (TA G), and to compare the cost of the topical anesthetic solutions with t he cast of lidocaine infiltration. Design: Randomized, double-blind cl inical trial. Setting: Urban pediatric emergency department. Participa nts: One hundred fifty-six children 3 to 18 years of age and older req uiring topical anesthesia for suturing of lacerations. Intervention: C hildren received 3 mt of one of the following study solutions: TAC 1 c onsisting of 0.5% tetracaine, 1:2000 dilution of adrenaline, 11.8% coc aine; TAC 2 that contained 1% tetracaine, 1:2000 dilution of adrenalin e, 4% cocaine; or TAC 3 made up of 1% tetracaine and 4% cocaine, witho ut adrenaline. Measurements or Main Results: Patients were randomized to group 1 (n=49), group 2 (n=49), or group 3 (n=58), and received TAC 1, TAC 2, or TAC 3, respectively. Patients in the three study groups were similar for age, gender, anatomic location and length of the lace ration, and history) of sutures or use of topical anesthesia. Based on the physician assessment of achievement of complete, partial, or no a nesthesia, solutions containing 11.8% cocaine (TAG 1) and 4% cocaine w ith adrenaline (TAG 2) were more likely to produce complete anesthesia than the solution with 4% cocaine without adrenaline (TAG 3) (P<.001, chi(2)) This difference was only noted when the laceration involved t he face or scalp. A second dose of the TAC 3 solution was more often r equired to produce anesthesia when compared with the other two study d rugs (P<.003, chi(2)). The final cost to produce 3 mt of the study dru gs, including the vials, was $16.39 for TAC 1, $8.67 for TAC 2, and $8 .41 for TAC 3. Conclusions: The application of a TAC solution containi ng 4% cocaine is as effective as a TAC solution containing 11.8% cocai ne. Use of the 4% solution decreases the cost of the agent. Adrenaline is a necessary ingredient in the anesthetic solution.