Prilocaine-phenylephrine and bupivacaine-phenylephrine topical anesthetics compared with tetracaine-adrenaline-cocaine during repair of lacerations

• Published in: The American journal of emergency medicine 1998-03, Vol.16 (2), p.121-124
• Main Authors: Smith, Gary A, Strausbaugh, Steven D, Harbeck-Weber, Cynthia, Cohen, Daniel M, Shields, Brenda J, Powers, Jean D, Barrett, Thomas
• Format: Article
• Language: English
• Subjects: Adolescent; Anesthesia, Local; Anesthetics, Local - administration & dosage; Anticonvulsants. Antiepileptics. Antiparkinson agents; Biological and medical sciences; bupivacaine; Bupivacaine - administration & dosage; Child; Child, Preschool; Cocaine - administration & dosage; Dermatologic Surgical Procedures; Double-Blind Method; emergency department; Emergency Service, Hospital; Epinephrine - administration & dosage; Female; Hospitals, Pediatric; Humans; Infant; laceration; Male; Medical sciences; Neuropharmacology; Pain - prevention & control; Pain Measurement; Pharmacology. Drug treatments; Phenylephrine - administration & dosage; Prilocaine; Prilocaine - administration & dosage; Prospective Studies; Safety; Skin - injuries; Suture Techniques; TAC; Tetracaine - administration & dosage; topical anesthesia; Vasoconstrictor Agents - administration & dosage
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/S0735-6757(98)90026-2

The effectiveness of two new topical anesthetics that do not contain cocaine (prilocaine-phenylephrine and bupivacaine-phenylephrine) was compared with that of tetracaine-adrenaline-cocaine (TAC) during laceration repair in children. This study was a prospective, randomized, double-blind trial conducted in the emergency department of a large children's hospital. Participants were 180 children 1 year of age or older with a laceration 5 cm or less in length that required suturing. Pain felt during suturing was scored by suture technicians, research assistants, parents, and patients 5 years of age and older using a visual analogue scale (VAS). There was no statistical difference demonstrated between the effectiveness of prilocaine-phenylephrine and that of TAC for any of the observer groups. A statistically significant difference was seen among anesthetics when comparing VAS scores of research assistants ( P = .002), suture technicians ( P = .006), and parents ( P = .03), but not when comparing VAS ratings of patients ( P = .07). Based on Tukey's post hoc test, these statistically significant differences were between TAC and bupivacaine-phenylephrine. When power analyses were performed using α = 0.05 and β = 0.20, it was possible to detect a difference of 1.3 VAS units for each rater group. In conclusion, this study demonstrated the effectiveness and safety of prilocaine-phenylephrine and bupivacaine-phenylephrine. Prilocaine-phenylephrine statistically outperformed bupivacaine-phenylephrine and offers an effective alternative to TAC during laceration repair in children.