• Itai Shavit, Yael Peri-Front, Anda Rosen-Walther, Ruth E Grunau, Gal Neuman, Omri Nachmani, Gideon Koren, and Dror Aizenbud.
• Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel.
• Pain Med. 2017 Feb 1; 18 (2): 356-362.

ObjectiveTo examine the comparative effectiveness of two topical anesthetics in controlling the pain associated with tongue-tie release (frenotomy) in young infants.DesignRandomized trial.SettingA Pediatric Craniofacial Clinic.SubjectsForty-two infants who were referred for frenotomy were randomly allocated to receive the topical anesthetic gel 2% tetracaine or 20% benzocaine applied prior to frenotomy. Frenotomies were videotaped. The primary outcome measure was the Neonatal Facial Coding System (NFCS) score. Secondary outcome measures included cry duration and a visual analog scale (VAS) assessed by the parents.ResultsThe two groups were comparable with regard to weight, age, gender, previous painful experience, and last feeding time. Median NFCS scores prior to frenotomy in the tetracaine and the benzocaine groups were 4.5 (IQR: 0.75–10.2) and 3.5 (IQR: 0–9.5), respectively (P = 0.89, 95% CI −3 to 4). During frenotomy, median NFCS score increased to 28 (IQR: 24.5–30.25) in the tetracaine group (P < 0.0001, median difference −22, 95% CI −24.5 to −19), and to 28 (IQR: 26–30) in the benzocaine group (P < 0.0001, median difference −23, 95% CI −27 to −17). Mean cry durations in the tetracaine and the benzocaine groups were 69.4 seconds and 63.9 seconds, respectively (P = 0.32, 95% CI −47 to 15), and mean VAS scores were 57.2 and 58.2, respectively (P = 0.89, 95% CI −15.2 to 13.4).ConclusionsThese topical anesthetics seem ineffective in controlling the pain associated with frenotomy. Clinicians should continue to search for an effective treatment for this procedure.

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