PRILOCAINE-PHENYLEPHRINE AND BUPIVACAINE-PHENYLEPHRINE TOPICAL ANESTHETICS COMPARED WITH TETRACAINE-ADRENALINE-COCAINE DURING REPAIR OF LACERATIONS

The effectiveness of two new topical anesthetics that do not contain c ocaine (prilocaine-phenylephrine and bupivacaine-phenylephrine) was co mpared with that of tetracaine-adrenaline-cocaine (TAG) during lacerat ion repair in children. This study was a prospective, randomized, doub le-blind trial conducted in the emergency department of a large childr en's hospital. Participants were 180 children 1 year of age or older w ith a laceration 5 cm or less in length that required suturing. Pain f elt during suturing was scored by suture technicians, research assista nts, parents, and patients 5 years of age and older using a visual ana logue scale (VAS). There was no statistical difference demonstrated be tween the effectiveness of prilocaine-phenylephrine and that of TAC fo r any of the observer groups. A statistically significant difference w as seen among anesthetics when comparing VAS scores of research assist ants (P = .002), suture technicians (P = .006), and parents (P = .03), but not when comparing VAS ratings of patients (P = .07). Based on Tu key's post hoc test, these statistically significant differences were between TAC and bupivacaine-phenylephrine. When power analyses were pe rformed using alpha = 0.05 and beta = 0.20, it was possible to detect a difference of 1.3 VAS units far each rater group. In conclusion, thi s study demonstrated the effectiveness and safety of prilocaine-phenyl ephrine and bupivacaine-phenylephrine. Prilocaine-phenylephrine statis tically outperformed bupivacaine-phenylephrine and offers an effective alternative to TAC during laceration repair in children. Copyright (C ) 1998 by W.B. Saunders Company.