ABSTRACT
OBJECTIVE: To compare the effectiveness of four topical anesthetics that do not contain cocaine with that of topical tetracaine-addrenaline-cocaine (TAC) and lidocaine infiltration during laceration repair in children. DESIGN: This was a randomized, blinded trial. SETTING: The study was conducted in the emergency department of a large children's hospital. PARTICIPANTS: Subjects were children 2 years of age or older with a laceration 5 cm or less in length that required sururing. INTERVENTIONS: Patients were randomly assigned to receive one of four noncocaine-containing topical anesthetics, topical TAC, or lidocaine infiltration anesthesia before laceration repair. OUTCOME MEASURES: Outcome measures assessed pain perceptions using a Visual Analogue Scale, Likert scale, and Anethetic Effectiveness scale. Distress behaviors of patients were measured with the Restrained Infants and Children Distress Rating Scale. RESULTS: Two hundred forty patients were enrolled in the study. Using alpha = 0.05 and beta = 0.2, there was statistical power to detect differences of 0.3 to 1.3 U for the outcome measures used. The bupivacaine-norepinephrine topical solution (Bupivanor) performed better than the other three new topical preparations. It provided effective wound anesthesia during lacertion repair, especially for lacerations of the face and scalp, where it was consistently rated as effective as TAC and 1% lidocaine infiltration by all observer groups for all outcome measures. There was a 4% overall wound complication, including one wound infection. CONCLUSION: Bupivanor is an effective alternative to TAC and lidocaine infiltration for local anesthesia during laceration repair, expecially on the face and scalp. The effectiveness of Bupivanor on the face is important, because it is here where TAC is most likely inadvertently to come into contact with mucous membranes and result in systemic toxicity. Because pain and distress scores did not take into consideration the pain associated with the initial injection of lidocaine, the findings of this study conservatively estimate Bupivanor's effectiveness, compared with lidocaine infiltration.
Subject(s)
Anesthetics, Local/therapeutic use , Bupivacaine/therapeutic use , Cocaine/therapeutic use , Epinephrine/therapeutic use , Lidocaine/therapeutic use , Norepinephrine/therapeutic use , Tetracaine/therapeutic use , Wounds, Penetrating/therapy , Administration, Cutaneous , Adolescent , Child , Child, Preschool , Double-Blind Method , Drug Combinations , Female , Humans , Male , Pain/etiology , Pain Measurement , Suture Techniques/adverse effectsABSTRACT
The Orange County Department of Mental Health developed a code of ethics to give its variety of employees a single set of standards for patient care and professional behavior in a community mental health program. The need for the code grew from problems of role definition and interdisciplinary collaboration that repeatedly arose during the program's development. General principles for the code were extracted from various professional codes, from issues arising in the day-to-day workings of the program, and from existing laws. The code, presented here, defines principles related to confidentiality, professional conduct, quality of service, moral and legal standards, clients' rights, and therapist-client relationships.
