• Anthony Eidelman, Jocelyn M Weiss, Ikay K Enu, Joseph Lau, and Daniell B Carr.
• Department of Anesthesiology and Pain Medicine, Caritas St. Elizabeth's Medical Center, Boston, MA 02135, USA.
• J Clin Anesth. 2005 Mar 1;17(2):106-16.

Study ObjectivesTo compare the efficacy of infiltrated local anesthesia with topical anesthesia for repair of dermal laceration, to analyze the efficacy of single or multicomponent topical anesthetics, and to identify topical formulations that are potentially less costly and equally efficacious as cocaine-containing topical anesthetics.DesignSystematic review of randomized controlled trials.SettingUniversity-affiliated hospital.PatientsPediatric and adult subjects.Measurements And Main ResultsTwenty-two trials that randomized more than 3000 patients were identified. The majority of studies demonstrated equivalent or superior analgesic efficacy for topical formulations compared with conventional intradermal infiltration. We found that cocaine is not a mandatory component of topical anesthesia. The literature discloses no significant difference in anesthetic efficacy between topical tetracaine-epinephrine-cocaine and each of the following 6 cocaine-free formulations: lidocaine-epinephrine-tetracaine, lidocaine-epinephrine, tetracaine-phenylephrine, tetracaine-lidocaine-phenylephrine, bupivicaine-norepinephrine, or prilocaine-phenylephrine.ConclusionTopical anesthetics are an efficacious, noninvasive means of providing analgesia before suturing of dermal lacerations. The use of cocaine-containing topical anesthetics can no longer be justified in light of its high cost and potential adverse effects. We have summarized the evidence, mostly favorable, supporting the use of various non-cocaine-containing topical anesthetics.

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