TOPICAL ANESTHESIA - CURRENT INDICATIONS, OPTIONS, AND EVIDENCE IN THE REPAIR OF UNCOMPLICATED LACERATIONS

OBJECTIVE To consider topical anesthetic options available to primary care physicians, indications for their use, and efficacy and safety of these agents as supported by the literature. QUALITY OF EVIDENCE Five randomized controlled trials were retrieved that compared various top ical anesthetics as well as topical anesthetics versus infiltrative an esthesia. MAIN FINDINGS A combination of lidocaine, epinephrine, and t etracaine (LET) is currently the topical anesthetic of choice for repa ir of simple lacerations involving the faces and scalps of children. A promising new topical preparation is bupivacaine and epinephrine, but its efficacy must be studied in larger populations before widespread use can be advocated. Using EMLA (eutectic mixture of local anesthetic s) for repair of extremity lacerations requires further study and cann ot yet be I recommended. Continued use of topical tetracaine, adrenali ne, and cocaine (TAC) is not supported in the literature, because of i ts greater expense, its status as a restricted narcotic, its potential for toxicity, and better availability of an equally efficacious alter native, LET. CONCLUSIONS Children's simple facial and scalp laceration s can be safely repaired using topical LET gel. Physicians must adhere to recommendations to avoid mucous membrane contact and ensure approp riate dosing with these agents. Bupivacaine-epinephrine topical prepar ation is a promising analgesic agent that warrants further study.