Prilocaine-phenylephrine and bupivacaine-phenylephrine topical anesthetics
compared with tetracaine-adrenaline-cocaine during repair of lacerations.
Author(s): Smith GA, Strausbaugh SD, Harbeck-Weber C, Cohen DM, Shields BJ, Powers JD,
Barrett T.
Affiliation(s): Department of Pediatrics, The Ohio State University College of Medicine,
Columbus, USA.
Publication date & source: 1998, Am J Emerg Med. , 16(2):121-4
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 alpha = 0.05 and beta = 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.
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