COMPARISON OF TOPICAL ANESTHETICS WITH LIDOCAINE INFILTRATION DURING LACERATION REPAIR IN CHILDREN

This study is a randomized, blinded trial that compares the effectiven ess of a new topical anesthetic preparation of 2% mepivacaine and 1:10 0,000 norepinephrine (Mepivanor); a topical solution of 1% tetracaine, 1:4,000 adrenaline, and 4% cocaine (TAG); and 1% lidocaine infiltrati on during laceration repair in children. The study was conducted in th e emergency department of a large academic children's hospital. Study participants were children 2 years of age or older with a laceration o n the face or scalp, 5 cm or less in length, that required suturing. P atients were randomly assigned to receive Mepivanor topical solution, TAC topical solution, or lidocaine infiltration anesthesia prior to la ceration repair. Seventy-one patients were enrolled in the study durin g a 2-month period. Outcome measures assessed pain perceptions using a Visual Analogue Scale (VAS) and a seven-point Likert scale. There was statistical power to detect differences of 1.2 to 1.7 units for the V AS outcome measures using alpha = 0.05 and beta = 0.20. There were no statistically significant (P>0.05) differences between TAC and 1% lido caine infiltration in providing effective anesthesia, Mepivanor was ge nerally less effective in providing adequate anesthesia during lacerat ion repair than TAC and lidocaine infiltration. with Tukey's post hoc test for ANOVA demonstrating statistically significant (P<0.05) differ ences between Mepivanor and these agents for research assistant and su ture technician VAS scores, Wound blanching was judged to be less with Mepivanor than with TAG! although this difference was nor statistical ly significant. There were no adverse reactions, wound infections, or healing difficulties for any of the patients who received TAC or Mepiv anor. It was concluded that non-cocaine-containing Mepivanor was gener ally less effective than TAC and lidocaine infiltration in providing a dequate local anesthesia during laceration repair. TAC containing only 120 mg of cocaine (3 mt of 4% cocaine) was as effective as 1% lidocai ne infiltration in providing local anesthesia during laceration repair . This will allow the amount of cocaine in TAC to be reduced, thereby decreasing costs and the likelihood of adverse reactions.