Tetracaine, Epinephrine (Adrenalin), and Cocaine (TAC) Versus Lidocaine, Epinephrine, and Tetracaine (LET) for Anesthesia of Lacerations in Children☆,☆☆,★,★★
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INTRODUCTION
Topical anesthesia for repair of minor lacerations in children has been used with good success.1, 2, 3, 4When placed on a laceration, solutions of tetracaine (0.5%), epinephrine (Adrenalin; 0.05%), and cocaine (11.8%) (TAC) have been approximately 90% effective in providing complete or partial anesthesia.2, 3The rationale for this combination of ingredients is that tetracaine and cocaine provide excellent local anesthesia whereas epinephrine and cocaine cause vasoconstriction. Vasoconstriction
MATERIALS AND METHODS
One hundred seventy-one male and female pediatric patients were enrolled in a double-blind, randomized, controlled trial comparing TAC and LET local anesthetic solutions. All patients were admitted to the emergency department at Minneapolis Children's Medical Center, a university-affiliated private children's hospital, between June 1992 and May 1993. Patients were eligible for inclusion in the study if they presented to the ED with an uncomplicated laceration on the face or scalp for which the
RESULTS
One hundred seventy-one patients were enrolled. Each patient had one laceration that required suturing. Five patients were excluded after consent was obtained. One of the 5 patients had been sedated with midazolam before anesthetic application, 2 of the 5 patients had the anesthetic solution applied for other than 15 minutes, and data were lost for the other 2 patients. Fifteen patients were withdrawn from the study before the initial 27-gauge needle test when the patient became uncooperative
DISCUSSION
For children with dermal lacerations that require debridement, irrigation, and suturing, adequate local anesthesia is essential. Topical anesthesia is preferred over infiltration anesthesia for a variety of reasons. Less trauma is associated with drug administration, there is a rapid onset of effect, and complete anesthesia is often experienced by the patient. In the past decade, TAC solution has slowly gained acceptance as the topical anesthetic of choice for laceration repair in pediatric
CONCLUSION
LET is an effective alternative to TAC for topical anesthesia during suturing of uncomplicated lacerations on the face and scalp in children. As a topical anesthetic with cocaine omitted, LET solution provides an inexpensive alternative that can be used in hospital EDs, clinics, and urgent-care centers. The removal of pure powdered cocaine should diminish hospital inventory of this controlled substance. Further study is necessary to examine the incidence of wound infection after laceration
Acknowledgements
The authors gratefully acknowledge the suture nurses of the ED and Rhonda Schoeberl of the Pharmacy Department at Minneapolis Children's Medical Center for their important contributions to this project.
References (13)
- et al.
Local anesthesia in minor lacerations: Topical TAC vs lidocaine infiltration
Ann Emerg Med
(1980) Clinical comparison of TAC anesthetic solutions with and without cocaine
Ann Emerg Med
(1985)Fatality secondary to the misuse of TAC solution
Ann Emerg Med
(1988)- et al.
Topical anesthesia for laceration repair: Tetracaine versus TAC (tetracaine, adrenaline, and cocaine)
Am J Emerg Med
(1986) - et al.
Safety and efficacy of using high-dose topical and nebulized anesthesia to obtain endobronchial cultures
Chest
(1989) - et al.
Lidocaine concentrations in bronchoscopic specimens
Chest
(1988)
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2010, Clinical Pediatric Emergency MedicineCitation Excerpt :Effective local anesthesia greatly reduces anxiety and the need for procedural sedation,36 particularly when needleless and nearly painless placement of anesthetics can be achieved. Placing topical anesthetic solutions or gels containing 4% lidocaine, 0.1% epinephrine, and 0.5% tetracaine into lacerations is nearly painless and provides local anesthesia sufficient for suturing in most children.37-39 These solutions are more effective in scalp and facial wounds, as blood supply to these areas is high.
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From the Clinical Pharmacy Department*, and Emergency Department‡, Minneapolis Children's Medical Center, Minnesota; and the Department of Pharmacy Practice, College of Pharmacy, University of Minnesota.§
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Financial support for this study was provided by the FA Bean Education and Research Fund, Minneapolis Children's Medical Center.
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Address for reprints: Craig G Schilling, PharmD, Clinical Pharmacy Department, Minneapolis Children's Medical Center, 2525 Chicago Avenue South, Minneapolis, Minnesota 55404, 612-863-6595, Fax 612-863-6365
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