Tetracaine, Epinephrine (Adrenalin), and Cocaine (TAC) Versus Lidocaine, Epinephrine, and Tetracaine (LET) for Anesthesia of Lacerations in Children,☆☆,,★★

Presented at the Ambulatory Pediatric Association meeting, Washington, DC, May 1993 and at the American College of Clinical Pharmacy meeting, Reno, Nevada, August 1993.
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Abstract

Study objective: To compare the duration of anesthesia experienced with lidocaine, epinephrine, and tetracaine (LET) solution and that with tetracaine, epinephrine (Adrenalin), and cocaine (TAC) solution during suturing of uncomplicated lacerations on the face or scalp.

Design: Double-blind, randomized, controlled trial. Setting: The emergency department of a university-affiliated private children's hospital. Participants: One hundred seventy-one children with lacerations on the face and scalp requiring suturing. Interventions: After standard application of the anesthetic solution, patients were assessed for signs of discomfort before and during laceration repair. Duration of anesthesia during laceration repair was determined on the basis of the length of time after removal of the anesthetic solution to the first sign(s) of discomfort that required additional anesthesia. Results: There was no statistical difference between TAC and LET in adequacy of anesthesia before suturing or in duration of anesthesia during suturing. Conclusion: LET is an effective alternative to TAC for topical anesthesia during suturing of uncomplicated lacerations on the face and scalp in children. [Schilling CG, Bank DE, Borchert BA, Klatzko MD, Uden DL: Tetracaine, epinephrine (Adrenalin), and cocaine (TAC) versus lidocaine, epinephrine, and tetracaine (LET) for anesthesia of lacerations in children. Ann Emerg Med February 1995;25:203-208.]

Section snippets

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.

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    Citation 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.

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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