Role modelling as a teaching method.
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Biomedical subjects
Publications and source records attributed to A Charters.
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This paper will critically review all the research carried out over the past 18 years concerning the use of topical anaesthetics for anaesthetizing wounds prior to closure. The review follows guidelines set out by Pollit and Hungler (1995) and Avis (1994) for critiquing research studies, and concentrates on the literature search, research objectives and design, data collection methods, sampling and data analysis.
OBJECTIVE: To compare the anaesthetic properties of conventional intradermal 1% plain lignocaine with a topical gel preparation of adrenaline (1:2000) and cocaine (4.7%) for use in treatment of children's lacerations. METHODS: Children aged 3-16 years with lacerations (not of the digits or mucous membranes) were consecutively assigned to receive either adrenaline and cocaine (AC) or lignocaine. Pain scores, as perceived by patients, parents, and staff, were measured conventionally using Wong Baker faces and visual analogue scales on administration of the local anaesthetic and on suturing the wound in the AC group (n = 56) and the lignocaine group (n = 51). RESULTS: Mean and median pain scores on administration of the anaesthetic in the AC group were significantly lower than in the lignocaine group as perceived by patient (P < 0.001), parent (P < 0.001), and staff (P < 0.001). There was no significant difference in mean and median pain scores between the two groups on suturing the wounds, as perceived by patient, parent and staff. There was a significantly higher number of "failed" anaesthetics (pain scores 8-10) in the lignocaine group (P < 0.01). On direct questioning the overall procedure was considered acceptable by 84.5% of parents in the AC group compared with 61% of parents in the lignocaine group (P < 0.01). There were no significant complications in either group. CONCLUSIONS: Topical AC should be considered the local anaesthetic of first choice for suturing appropriate children's lacerations.
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