Study objective: To evaluate the anesthetic efficacy of a gel form of adrenaline-cocaine topical medication for minor dermal laceration repair.
Design: Unblinded, prospective.
Setting: An urban pediatric emergency department.
Type of participants: Thirty-five children aged 20 months to 18 years with lacerations of the face, outer lip, and scalp.
Interventions: All received adrenaline-cocaine gel made by mixing 1.5 mL of conventional adrenaline-cocaine liquid (adrenaline, 1:2,000; cocaine, 11.8%) with 0.15 g of methylcellulose powder (an inert emulsifying agent).
Measurements and main results: Lacerations were located on the face or outer lip in 25 patients and on the scalp in ten patients. Larger lacerations (length of more than 5 cm and/or depth of more than 5 mm) occurred in nine patients. The average dose of adrenaline-cocaine gel applied per laceration was 0.35 mL (containing 40 mg cocaine). One hundred ninety-five sutures were placed (175 cutaneous, 20 subcutaneous); 192 (98.5%) were placed without eliciting any pain. There were no observed adverse reactions with adrenaline-cocaine gel administration or reported complications of wound healing in any patient.
Conclusion: Adrenaline-cocaine gel preparation provides excellent anesthetic efficacy for minor dermal lacerations in children. Compared with conventional adrenaline-cocaine liquid, adrenaline-cocaine gel may be advantageous in reducing the total cocaine requirement and may diminish the risk for adverse reactions that can result from runoff of liquid medication onto mucosal or ocular surfaces.