Anderson 1990.

Methods	Single‐centre RCT, paediatric emergency department, United States
Participants	151 patients younger than 18 years old with lacerations on the scalp (n = 31), face (n = 79) or extremity (n = 41)
Interventions	1. Topical TAC solution (tetracaine 0.5%, epinephrine 1:2000, cocaine 11.8%), applied for 5 to 10 minutes (n = 56) 2. Intradermal infiltration with lidocaine 1% (n = 53) 3. Topical placebo solution, applied for 5 to 10 minutes (n = 42)
Outcomes	1. Before laceration repair, the physician probed the wound with a 25‐gauge needle to determine adequacy of initial anaesthesia. 2. The physician graded participant compliance during the suturing process on a 4‐point scale (1 ‐ complete compliance, 2 ‐ occasional resistance, 3 ‐ frequent resistance, 4 ‐ continuous resistance). 3. Supplemental lidocaine infiltration was required. Results of topical TAC versus topical placebo include the following. 1. Adequate initial anaesthesia (topical TAC = 89% vs topical placebo = 17%; P < 0.0001) 2. Physician compliance scale (1‐4) ratings (complete compliance to continuous resistance) (mean score ± SD: topical TAC = 1.25 ± 0.57 vs topical placebo = 1.93 ± 0.96; P < 0.002) 3. Requirement of supplemental lidocaine infiltration (topical TAC = 18% vs topical placebo = 83%; P < 0.0001) Results of topical TAC versus infiltrated local anaesthetic include the following. 1. Adequate initial anaesthesia (topical TAC = 89% vs infiltrated local anaesthetic = 79%; P = non‐significant) 2. Physician compliance scale (1‐4) ratings (complete compliance to continuous resistance) (mean score ± SD: topical TAC = 1.25 ± 0.57 vs infiltrated local anaesthetic = 1.94 ± 1.12; P < 0.002) 3. Requirement of supplemental lidocaine infiltration (topical TAC = 18% vs infiltrated local anaesthetic = 23%; P = non‐significant)
Intervention dates	August 1986 to May 1987
Declaration of interest	Not reported
Notes	Funding not reported
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	Quote: "The last digit of the patient's medical record number was used to enter patients into either the intradermal or topical group". Comment: probably not done
Allocation concealment (selection bias)	High risk	Quote: "The last digit of the patient's medical record number was used to enter patients into either the intradermal or topical group". Comment: probably not done
Blinding (performance bias and detection bias) All outcomes	High risk	Quote: "Individual study vials containing 5ml of TAC or placebo were prepared in the pharmacy of University of Massachusetts Medical Center following a standard protocol and assigned numbers"; "The ED staff member evaluating and suturing the patient were blind to the solution contained in the vials". Comment: Comparisons of topical TAC and topical placebo were probably blinded. However, comparisons between lidocaine infiltration and topical TAC were probably unblinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	153 eligible patients, 2 refused to participate. 151 randomized, no missing outcome data
selective reporting of outcomes All outcomes	Unclear risk	All outcomes discussed in Methods section reported in Results. Subgroup analysis based on location of laceration was not prespecified.
Other bias (sample size)	High risk	56 TAC: 53 lidocaine 42 placebo