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28-07-2011 | Dermatology | Article

Topical anesthetics useful for pain relief when repairing skin wounds


Free abstract

MedWire News: Findings from a Cochrane systematic review suggest that cocaine-free topical anesthetics are effective for pain relief during skin wound repair.

"The research clearly showed that cocaine-free topical anesthetics can substantially reduce pain without triggering serious side effects," said study researcher Anthony Eidelman from the Washington University School of Medicine in St Louis, Missouri, USA.

The methods used to apply the anesthetics and test the level of pain relief achieved varied significantly between the studies, and most individual studies had small patient groups, making more detailed conclusions difficult, says the team.

"We need to encourage people to do more research using non-cocaine topical anesthetics, but this time perform the research in ways that are sufficiently rigorous. These agents look promising at the moment, but it would be great to confirm their value with high-quality research," commented Eidelman.

The researchers included 23 randomized controlled trials in the analysis, involving 3128 patients in total. The trials compared the efficacy and safety of injected versus topical local anesthetics for the repair of skin lacerations.

Cocaine was among the first anesthetics to be successfully topically applied, but due to concerns about adverse effects and administrative problems with dispensing a controlled substance, cocaine-free alternatives have been developed. The researchers therefore compared cocaine-based with cocaine-free topical anesthetics to see if the latter resulted in fewer side-effects than the former.

Eidelman and colleagues report in the Cochrane Database of Systematic Reviews that several of the cocaine-free anesthetics provided effective pain relief during wound repair, but note that the risk for bias between trials was unclear or high.

Skin hardening and redness was reported as a result of topical tetracaine-adrenaline-cocaine (TAC) application in one patient out of 1042, but otherwise no significant adverse effects were reported for any patients treated with cocaine-based or cocaine-free anesthetics.

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Helen Albert