Resch 1998.

Methods	Single‐centre RCT, emergency department, University of Minnesota‐affiliated Children’s Hospital, Minneapolis, Minnesota, United States
Participants	194 paediatric patients with lacerations of the face and scalp
Interventions	1. Topical LAT solution (lidocaine 4%, epinephrine 1:2000, tetracaine 0.5%), applied for 20 minutes (n = 103) 2. Topical LAT gel (lidocaine 4%, epinephrine 1:2000, tetracaine 0.5%), applied for 20 minutes (n = 91)
Outcomes	1. The physician assessed the adequacy of initial anaesthesia by probing the wound with a 27‐gauge needle. If any pain was elicited with probing, the anaesthetic was considered 'inadequate' and infiltrated lidocaine was given. 2. At the conclusion of laceration repair, the physician rated anaesthetic effectiveness (complete, partial or incomplete) based on painful responses during suturing. 3. The study reported acute adverse reactions directly related to the anaesthetic. Results include the following. 1. Adequacy of initial anaesthesia (adequate anaesthesia: LET solution = 84% vs LET gel = 82%; P > 0.05) 2. Effectiveness of anaesthesia (complete anaesthesia: LET solution = 76% vs LET gel = 85%; P = 0.007) 3. No acute anaesthetic‐related adverse effects
Intervention dates	March 1995 to March 1996
Declaration of interest	Not reported
Notes	Funding not reported
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "A computer‐generated random number table was used by a hospital pharmacy personnel to label standard amber vials from 1 to 200". Comment: probably done
Allocation concealment (selection bias)	Low risk	Quote: :hospital pharmacy personnel to label standard amber vials from 1 to 200" "it was required that the study medication be applied by a nurse not involved in the suturing" Comment: probably done
Blinding (performance bias and detection bias) All outcomes	Low risk	Quote: "To ensure blinding of suture personnel, in the trial, it was required that the study medication be applied by a nurse not involved in the suturing" Comment: probably done
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	200 participants enrolled and 3 withdrawn before test of initial anaesthesia because participants were unco‐operative or complicated laceration did not meet inclusion criteria. Of the 197 available for analysis, 3 data sheets were inadvertently lost. We concluded low risk of bias because plausible effect size among missing outcomes was not enough to have a clinically relevant impact on observed effect size.
selective reporting of outcomes All outcomes	Unclear risk	All prespecified primary and secondary outcomes were reported: physician determination of adequacy of anaesthetic before repair and anaesthetic effectiveness during repair. Adverse effects also reported Quote: “Pain assessment was a 2‐stage process that evaluated adequacy of anaesthesia before suturing and effectiveness of anaesthesia during suturing”. “Effectiveness of anaesthesia during suturing was divided into 3 categories: complete, partial, and incomplete”. “Complications assessed were redness, drainage, fever, tenderness, swelling, or contact with medical personnel for wound‐related issues other than suture removal”. Quote: “Of the 194 patients, 162 (83.5%) obtained adequate anaesthesia as determined by the 27‐gague needle test”. Table 3. Efficacy of LET solution versus LET gel for topical anaesthesia of face and scalp (includes information on complete, partial and Incomplete effectiveness) Complications: “No adverse effects were noted in the 194 patients during the procedure. 13 patients who were not able to be contacted… one patient in each study arm sought medical care for a wound infection".
Other bias (sample size)	Unclear risk	Quote: “LET solution = 103 subjects, LET gel = 91 subjects”