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Contact dermatitis and bradycardia in a preterm infant given tetracaine 4% gel
Anna Taddio1, Charlene M Lee, Boriana Parvez
1Department of Pharmacy and Population Health Sciences, The Hospital for Sick Children, Toronto, Canada. anna.taddio@sickkids.ca
Insights
Tetracaine gel may cause skin reactions in newborns, but bradycardia is unlikely. Careful skin monitoring is advised when using this topical anesthetic for pain management in neonates.
Area of Science:
- Neonatal pharmacology
- Pediatric anesthesiology
- Adverse drug event reporting
Background:
- Analgesic use for procedural pain in neonates is increasing.
- Potential for drug-induced side effects and misattribution of adverse events exists.
- Topical local anesthetics like tetracaine are used for neonatal pain relief.
Observation:
- A preterm infant receiving tetracaine gel for central venous catheter placement experienced bradycardia.
- The same infant later developed a desquamating local cutaneous reaction at the application site.
- An adverse drug reaction probability scale (Naranjo et al.) was used to assess causality.
Findings:
- Bradycardia was determined to be unlikely caused by tetracaine.
- The local cutaneous reaction, progressing to desquamation, was probably caused by tetracaine.
- This is the first reported case of a serious skin reaction in a neonate treated with tetracaine.
Implications:
- Tetracaine gel can likely still be used for neonatal pain management.
- Vigilant skin evaluation is crucial during and after tetracaine gel administration.
- Further research into neonatal skin reactions to topical anesthetics is warranted.
Abstract:
The use of analgesics for procedural pain management in the newborn infant has been steadily increasing during the past decade. With this trend of increased analgesic utilization, there is the potential for infants to suffer from drug-induced side effects. There also is the potential to wrongfully blame drugs for all adverse events that occur during analgesic use. Two adverse events that occurred in a neonate exposed to tetracaine gel and the probability that the adverse events were caused by the drug are presented. During administration of the topical local anesthetic tetracaine for analgesia during percutaneous central venous catheter placement, a preterm infant experienced bradycardia. Several hours later, a local cutaneous reaction that progressed to skin desquamation occurred at the site. The authors assessed the probability that tetracaine caused 2 adverse events using a validated adverse drug reaction probability scale by Naranjo et al. According to the algorithm developed by Naranjo et al, it was determined that bradycardia was unlikely caused by the drug; however, the dermal reaction was probably the result of the drug.The authors determined that tetracaine caused a serious local skin reaction, but not bradycardia, in a preterm infant. This is the first report of a serious skin reaction in a neonate treated with tetracaine. Based on these findings, tetracaine gel can continue to be used to treat pain in neonates with careful evaluation of the skin.
