Topical Anesthesia for Pediatric Lacerations: A Randomized Trial of Lidocaine-Epinephrine-Tetracaine Solution Versus Gel

Comparative efficacy and costs of various topical anesthetics for repair of dermal lacerations: a systematic review of randomized, controlled trials

“…The traumas were superficial and the length of the dermal injuries ranged from 1.5 to 10 cm. Adler et al 1998 4 [26] Ernst et al 1990 4 [33] Schilling et al 1995 4 [36] Resch et al 1998 3.5 [28] Kuhn et al 1996 3 [14] Smith et al 1996 3 [23] Smith and Barry 1990 3 [22] Vinci and Fish 1996 3 [29] Blackburn et al 1995 2.5 [30] Zempsky and Karasic 1997 2.5 [19] Anderson et al 1990 2 [24] Bonadio and Wagner 1990 2 [32] Ernst et al 1997 2 [27] Schaffer 1985 2 [15] Smith et al 1998 2 [20] Smith et al 1997 (a) 2 [16] Smith et al 1997 (b) 2 [25] White et al 1986 2 [21] Hegenberth et al 1990 0 [2] Pryor et al 1980 0…”

“…A nonblinded RCT that enrolled 467 pediatric patients [21] found a significantly greater analgesic efficacy for Adler et al [31] 60 Patients (z12 y) 15% 8% 77% V7 cm Anderson et al [19] 151 Pediatric (b18 y) 52% 21% 27% b5 cm Blackburn et al [29] 35 Adult + pediatric (N2 y) Yes a Yes a V6 cm Bonadio et al [24] 55 Pediatric (NR) Yes a NR Ernst et al [26] 139 Adult + pediatric (N5 y) 38% 24% 37% 0.7% b5 cm Ernst et al [34] 95 Pediatric (5-17 y) 67% 33% V7 cm Ernst et al [35] 95 Adult (NR) 85% 14% V7 cm Ernst et al [32] 66 Adult + pediatric (N5 y) 45% 15% 36% 1.5-10 cm Hegenberth et al [21] 467 Pediatric (7 mo-18 y) Yes a Yes a Yes a Yes a NR Kuhn et al [28] 180 Adult + pediatric (z6 y) 63% 37% 3-7 cm Pryor et al [2] 158 Patients (10 mo-53 y) NR NR NR NR NR Resch et al [36] 194 Pediatric (NR) Yes a Yes a NR Schaffer [27] 107 Pediatric (V10 y) 79% 21% NR Schilling et al [33] 171 Pediatric (1-17 y) 70% 30% NR Smith et al [15] 180 Pediatric (1-18 y) 42% 33% 24% V5 cm Simth et al [20] 71 Pediatric (2-16 y) 61% 39% V5 cm Smith et al [16] 240 Pediatric (1-18 y) 51% 30% 18% V5 cm Smith et al [14] 240 Pediatric (2-17 y) 56% 24% 20% V5 cm Smith et al [23] 250 Pediatric (15 mo-17 y) 60% 12% 28% NR Vinci et al [22] 156 Pediatric (3-18 y) 66% b 30% 4% NR White et al [25] 68 Adults (N18 y) 32% c NR Zempsky et al [30] 32 Pediatric ( lidocaine infiltration than topical TAC solution. The study did not directly assess pain intensity during wound closure.…”

“…Physician pain rating and percentage of sutures causing pain Ernst et al [32] Pain intensity VAS Physician VAS pain rating and percentage of sutures causing pain Hegenberth et al [21] None None Adequacy of anesthesia judged by probing wound with needle Kuhn et al [28] Pain intensity VAS or Wong-Baker faces scale Adequacy of anesthesia judged by probing wound with needle Pryor et al [2] Pain relief Verbal description of pain Anesthetic acceptability rating Resch et al [36] None None Adequacy of anesthesia by probing wound with needle and anesthetic effectiveness scale (complete, partial, incomplete) Schaffer [27] None None Anesthetic effectiveness scale (complete, partial, incomplete) Schilling et al [33] None None Adequacy of anesthesia by probing wound with needle and anesthetic effectiveness scale (complete, partial, incomplete) Smith et al [14] Pain intensity VAS VAS and Likert pain scores by observer groups, anesthetic, effectiveness scale, restrained infant and children distress rating Simth et al [20] None None VAS and Likert pain scores by observers groups and requirement of supplemental lidocaine infiltration Smith et al [16] Pain intensity VAS VAS and Likert pain scores by observer groups and pain relief assessed by practitioner (complete, partial, none) Smith et al [15] Pain intensity VAS VAS pain scores by observer groups Smith and Barry [23] Pain intensity Faces-pain scale Requirement of supplemental lidocaine infiltration Vinci and Fish [22] None None Pain relief assessed by physician (complete, partial, none) White et al [25] Pain intensity Verbal pain scale (0-10) Requirement of supplemental lidocaine infiltration Zempsky and Karasic [30] Pain intensity VAS Requirement of supplemental lidocaine infiltration [23] demonstrated no significant differences in analgesic efficacy between three distinct solutions: TAC 1 (tetracaine 0.5%, epinephrine 1:2000, cocaine 11.8%), TAC 2 (tetracaine 1.0%, epinephrine 1:4000, cocaine 7.0%), and TAC 3 (tetracaine 1.0%, epinephrine 1:4000, cocaine 4.0%). Anesthetic efficacy was categorized by the physician's or parent's estimate of patient discomfort during the procedure using a 9-point faces scale.…”

Pediatric Procedural Sedation and Analgesia

“…This agent has been shown to be more effective for scalp and facial lacerations than for truncal and extremity lacerations. Resch and colleagues 21 showed 85% complete anesthesia when repairing uncomplicated face and scalp lacerations with primary closure. LET is available as an aqueous solution or gel.…”

Pediatric Pain and Anxiety in the Emergency Department: An Evidence-Based Approach to Creating an Anti-Pain Environment

“…The gel formulation of LET was created to prevent this from happening. Resch et al compared the anesthetic effect of LET solution and LET gel and concluded that the two formulations are equivalent in efficacy in regards to initial anesthesia [42]. An important pearl related to LET gel is to make sure that it stays at the intended site.…”