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Consigning “brutacaine” to history: a survey of pharmacological techniques to facilitate painful procedures in children in emergency departments in the UK
  1. B Loryman1,
  2. F Davies2,
  3. G Chavada2,
  4. T Coats2
  1. 1Accident and Emergency Department, Kettering General Hospital, Kettering, Northants, UK
  2. 2Emergency Department, Leicester Royal Infirmary, Leicester, UK
  1. Correspondence to:
 B Loryman
 Accident and Emergency Department, Kettering General Hospital, Rothwell Road, Kettering, Northants NN16 8UZ, UK; ben.loryman{at}


Objective: To determine the proportion of emergency departments in the UK that use modern pharmacological methods of pain and anxiety control in children, such as analgesia with intranasal diamorphine, procedural sedation using ketamine or midazolam, and adrenaline–cocaine gel, TAC or LAT for anaesthetising wounds in children.

Methods: A survey UK Emergency Departments conducted by email, post and telephone.

Results: Of the 183 (70%) of UK Emergency Departments responding, sedation is achieved using ketamine in 27% and using midazolam in 54%. In 55% of emergency departments intranasal diamorphine is used for analgesia and 41% use at least one of the topical local-anaesthetic mixtures to anaesthetise wounds before suturing.

Conclusions: About half of UK emergency departments use modern pharmacological methods of procedural pain control in children. There is still considerable potential to improve the management of pain in children.

  • BAEM, British Association for Emergency Medicine
  • LAT, lingnocaine–adrenaline–tetracaine gel
  • TAC, tetracaine–adrenaline–cocaine gel

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  • Funding: There was no funding required for this study. All authors are independent from any sources of funding.

  • Competing interests: None.

  • This study did not involve direct contact with patients or their records and as such did not require approval from the local or multi-centre research ethics committees before commencement.

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