Topical anesthesia for pediatric lacerations: A randomized trial of lidocaine-epinephrine-tetracaine solution versus gel

Study objective: To compare the adequacy and efficacy of anesthesia experie nced with lidocaine-epinephrine-tetracaine (LET) solution versus LET gel du ring suturing of uncomplicated lacerations on the face or scalp in children . Methods: Two hundred children with lacerations of the face and scalp requir ing suturing were enrolled in this blinded, randomized controlled trial, in the emergency department of a university-affiliated children's hospital. A fter the application of anesthetic solution or gel, adequacy of anesthesia was determined before suturing. Efficacy of anesthesia during laceration re pair was determined by the length of time after removal of the topical anes thetic to the first sign of discomfort that required additional anesthesia or until suture completion. Results: Adequacy of initial anesthesia was equivalent between LET solution and LET gel. There was a significant difference in efficacy of anesthesia between the LET formulations. There were more patients with complete anesth esia (85% versus 76%), fewer persons with partial anesthesia (5% versus 21% ), and more persons with incomplete anesthesia (9% versus 3%) in the gel gr oup. Conclusion: LET gel is at least as effective as LET solution and possesses theoretical advantages for topical anesthesia during suturing of uncomplica ted lacerations on the face and scalp in children.