Comparison of lignocaine 1% injection and adrenaline‐cocaine gel for local anaesthesia in repair of lacerations

Abstract

ObjectiveTo compare adrenaline-cocaine gel (adrenaline 1:1000 [0.5ml], cocaine 12%[1ml]) with injectable lignocaine 1 % solution in efficacy, side effects and safety, cosmetic and patient acceptability in the repair of dermal lacerations on patients who attend the emergency department. DesignRandomised, prospective, singleblinded clinical trial. SettingRural base hospital emergency department. ParticipantsPatients presenting to the emergency department aged six years and over with dermal lacerations to face, scalp, trunk and limbs, excluding areas below knee or with end-artery blood supply. Those patients with altered mental state were also excluded. InterventionPatients with lacerations were randomly assigned to local anaesthesia with either topical adrenaline-cocaine gel or injection of lignocaine 1 % solution. Patients were then asked to rate the pain on application of either adrenaline-cocaine gel or lignocaine 1% solution. The emergency doctor who performed the local anaesthesia then sutured in the usual way. A blinded observer recorded pain response using verbal and visual indicators. MeasurementNinety patients participated in the trial: 49 randomised to lignocaine 1% solution and 41 to adrenaline-cocaine gel. A total of 924 skin punctures were recorded and measured. ConclusionAdrenaline-cocaine gel compared favourably with lignocaine 1% solution efficacy, side effects and cosmetic results. It was less painful on application than lignocaine 1%. Adrenaline-cocaine gel may be considered as an alternative for anaesthesia in the repair of selected dermal lacerations. 38 Emergency Medicine 1998 • Vol 10Comparison of lignocaine 1 % injection and adrenaline-cocame gel for local anaesthesia m repair of lacerations

The use of topical anaesthesia during repair of minor lacerations in Departments of Emergency Medicine: A literature review

“…Recently, the use of topical anaesthesia especially in children, has become more common (Bonadio and Wagner, 1992;Schilling et al, 1995;Dart, 1998) and it has been used for many years in the USA and Australia (Young et al, 2005). However, UK emergency departments have been slow to embrace this practice (Bush, 2000).…”