Randomized trial of novel tetracaine patch to provide local anaesthesia in neonates undergoing venepuncture

• Published in: British journal of anaesthesia : BJA Vol. 91; no. 4; pp. 514 - 518
• Main Authors: Long, C.P., McCafferty, D.F., Sittlington, N.M., Halliday, H.L., Woolfson, A.D., Jones, D.S.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.10.2003; Oxford University Press; Oxford Publishing Limited (England)
• Subjects: Administration, Cutaneous; anaesthetics local; anaesthetics local, tetracaine; Anesthesia, Local - methods; Anesthetics, Local - administration & dosage; Anesthetics. Neuromuscular blocking agents; Biological and medical sciences; Double-Blind Method; Female; Humans; Infant, Newborn; Intraoperative Complications - prevention & control; Male; Medical sciences; neonates; Neuropharmacology; pain; Pain - prevention & control; Pain Measurement - methods; Pharmacology. Drug treatments; Phlebotomy - methods; tetracaine; Tetracaine - administration & dosage; veins; veins, venepuncture; venepuncture; veins, venepuncture; pain; neonates; anaesthetics local, tetracaine; anaesthetics local, tetracaine; neonates; pain; veins, venepuncture; Human; anaesthetics local; Percutaneous route; Local anesthetic; tetracaine; neonates; pain; veins; Ester; venepuncture; Pain; Newborn; Local anesthesia; Dosage form; Puncture; Vein; Patch; Tetracaine
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aeg216

Procedures such as venepuncture or heel prick are painful and may cause considerable stress to newborn infants. Topical local anaesthetics are effective for venepuncture but need to be applied for at least 60 min and the delivered dose will vary. We assessed a novel tetracaine-based self-adhesive patch in providing controlled local anaesthesia before venepuncture. A placebo-controlled, double-blind trial was conducted using a tetracaine patch formulated from hydroxypropylcellulose discs (0.283 cm2) containing tetracaine (1 mg cm−2) surrounded by a low tack pressure-sensitive adhesive backing layer. Thirty-two newborn infants of gestation 32–42 weeks (median 36 weeks), aged 3–18 days (median 6 days) were randomized to receive a tetracaine-containing patch or a placebo device applied to the dorsum of the hand 30 min before venepuncture to obtain blood samples. Pain was assessed in response to needle insertion using a validated adaptation of the neonatal facial coding score (NFCS) and the presence of crying. Of 15 tetracaine-treated neonates, 14 (93%) presented little or no pain in response to the procedure compared with six of 17 (35%) who had the placebo patch applied (P=0.01). The tetracaine patch produced effective pain relief during the venepuncture procedure in both term and pre-term infants. There were no adverse effects, either local or systemic.