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Topical adrenaline and cocaine gel for anaesthetising children’s lacerations. An audit of acceptability and safety

¹ Maxillofacial Unit, University Hospital of Wales, Heath, Cardiff, UK
² Emergency Unit, University Hospital of Wales

Correspondence to:
Correspondence to:
Mr D W G Kennedy
Maxillofacial Unit, University Hospital of Wales, Heath, Cardiff CF64 1SP, UK; dwgkennedy{at}aol.com

Objectives: (1) To assess the acceptability of a gel solution of adrenaline (epinephrine) (1 in 2000) and cocaine (5%) for anaesthetising children’s facial lacerations to the child, parent, and operator. (2) To assess the safety of the current protocol.

Setting: The emergency unit of a large university hospital.

Methods: All patients who were treated with topical adrenaline and cocaine (topAC) gel over a six month period were entered into a prospective audit (n = 75). Patient details, the nature and cause of the injury, and any treatment carried out were all recorded. The acceptability to children over 3 years of age, was assessed by the use of the Wong Baker face scale, in which 0 represents "no hurt" and 5 represents "hurts worst". The acceptability to both the parent and the operator was assessed by the use of a 0 to 9 Likert scale, where 0 represented "very acceptable" and 9 represented "not at all" acceptable.

Results: (1) Children aged 3 years or older graded their pain during the procedure as having a mean value of 1.17 on the Wong Baker (0 to 5) scale. Parents graded acceptability on the Likert scale (0 to 9) with a mean score of 1.13. Operators using the same grading system, recorded a mean score of 1.75. (2) No toxic side effects were seen but the protocol was updated in line with evidence.

Conclusions: Topical adrenaline and cocaine is an effective anaesthetic for suturing children’s facial lacerations and is acceptable to child, parent, and operator alike.

Keywords: adrenaline; cocaine; children; topical anaesthetic gel; epinephrine

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