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Article
May 1996

Efficacy of Topical Anesthesia in Children

Author Affiliations

From the Departments of Pediatrics (Dr Vinci) and Emergency Medicine (Dr Fish), Boston (Mass) City Hospital.

Arch Pediatr Adolesc Med. 1996;150(5):466-469. doi:10.1001/archpedi.1996.02170300020005
Abstract

Objectives:  To compare the efficacy of three formulations of a topical anesthetic solution composed of various concentrations of tetracaine hydrochloride, adrenaline (epinephrine), and cocaine hydrochloride (TAC), and to compare the cost of the topical anesthetic solutions with the cost of lidocaine infiltration.

Design:  Randomized, double-blind clinical trial.

Setting:  Urban pediatric emergency department.

Participants:  One hundred fifty-six children 3 to 18 years of age and older requiring topical anesthesia for suturing of lacerations.

Intervention:  Children received 3 mL of one of the following study solutions: TAC 1 consisting of 0.5% tetracaine, 1:2000 dilution of adrenaline, 11.8% cocaine; TAC 2 that contained 1% tetracaine, 1:2000 dilution of adrenaline, 4% cocaine; or TAC 3 made up of 1% tetracaine and 4% cocaine, without adrenaline.

Measurements or Main Results:  Patients were randomized to group 1 (n=49), group 2 (n=49), or group 3 (n=58), and received TAC 1, TAC 2, or TAC 3, respectively. Patients in the three study groups were similar for age, gender, anatomic location and length of the laceration, and history of sutures or use of topical anesthesia. Based on the physician assessment of achievement of complete, partial, or no anesthesia, solutions containing 11.8% cocaine (TAC 1) and 4% cocaine with adrenaline (TAC 2) were more likely to produce complete anesthesia than the solution with 4% cocaine without adrenaline (TAC 3) (P<.001, χ2). This difference was only noted when the laceration involved the face or scalp. A second dose of the TAC 3 solution was more often required to produce anesthesia when compared with the other two study drugs (P<.003, χ2). The final cost to produce 3 mL of the study drugs, including the vials, was $16.39 for TAC 1, $8.67 for TAC 2, and $8.41 for TAC 3.

Conclusions:  The application of a TAC solution containing 4% cocaine is as effective as a TAC solution containing 11.8% cocaine. Use of the 4% solution decreases the cost of the agent. Adrenaline is a necessary ingredient in the anesthetic solution.(Arch Pediatr Adolesc Med. 1996;150:466-469)

References
1.
Pryor GJ, Kilpatrick WR, Opp DR.  Local anesthesia in minor lacerations: topical TAC vs lidocaine infiltration . Ann Emerg Med . 1980;9:568-571.Article
2.
Schaffer DJ.  Clinical comparison of TAC anesthetic solutions with and without cocaine . Ann Emerg Med . 1985;14:75-78.Article
3.
Bonadio WA, Wagner V.  Efficacy of TAC topical anesthetic for repair of pediatric lacerations . AJDC . 1988;142:203-205.
4.
Hegenbarth MA, Altieri MF, Hawk WH, Greene A, Ochsenschlager DW, O'Donnell R.  Comparison of topical tetracaine, adrenaline, and cocaine anesthesia with lidocaine infiltration for repair of lacerations in children . Ann Emerg Med . 1990; 19:63-67.Article
5.
Ernst AA, Crabbe LH, Winsemius DK, Bragdon R, Link R.  Comparison of tetracaine, adrenaline, and cocaine with cocaine alone for topical anesthesia . Ann Emerg Med . 1990;19:51-54.Article
6.
Anderson AB, Colecchi C, Baronoski R, DeWitt TG.  Local anesthesia in pediatric patients: topical TAC versus lidocaine . Ann Emerg Med . 1990;19:519-522.Article
7.
Fitzmaurice LS, Wasserman GS, Knapp JF, Roberts DK, Waeckerle JF, Fox M.  TAC use and absorption of cocaine in a pediatric emergency department . Ann Emerg Med . 1990;19:515-518.Article
8.
Altieri M, Bogema S, Schwartz RH.  TAC topical anesthesia produces positive urine tests for cocaine . Ann Emerg Med . 1990;19:577-579.Article
9.
Terndrup TE, Walls HC, Mariani PJ, Gavula DP, Madden CM, Cantor RM.  Plasma cocaine and tetracaine levels following application of topical anesthesia in children . Ann Emerg Med . 1992;21:162-166.Article
10.
Jacobson S.  Errors in emergency practice . Emerg Med . 1987;19:109.
11.
Dailey RH.  Fatality secondary to misuse of TAC solution . Ann Emerg Med . 1988; 17:59-160.Article
12.
Wehner D, Hamilton GC.  Seizures following topical application of local anesthetics to burn patients . Ann Emerg Med . 1984;13:456-458.Article
13.
Thompson J, Peters J, Wieland M.  Seizures following ingestion of the topical anesthetic solution TAC . Vet Hum Toxicol . 1984;26( (suppl 2) ):44.
14.
Daya MR, Burton BT, Schleiss MR, Diliberti JH.  Recurrent seizures following mucosal application of TAC . Ann Emerg Med . 1988;17:646-648.Article
15.
Diem K, Lentner C, eds. Scientific Tables . 7th ed. Basel, Switzerland: Ciba-Geigy Ltd; 1970:131.
16.
Koplin LM:  Topical anesthesia in pediatric lacerations or putting away the papoose . Plast Reconstr Surg . 1987;79:669-670.Article
17.
Pierluisi GJ, Terndrup TE:  Influence of topical anesthesia on the sedation of pediatric emergency department patients with lacerations . Pediatr Emerg Care . 1989;5:211-215.Article
18.
White WD, Iserson KV, Criss E:  Topical anesthesia for laceration repair: tetracaine vs. TAC (tetracaine, adrenaline, and cocaine) . Am J Emerg Med . 1986; 4:319-322.Article
19.
Yaster M, Tobin JR, Fisher QA, Maxwell LG.  Local anesthetics in the management of pain in children . J Pediatr . 1994;124:165-176.Article
20.
Bonadio WA, Wagner V.  Half-strength TAC topical anesthetic . Clin Pediatr (Phila) . 1988;27:495-498.Article
21.
Bonadio WA, Wagner V.  Efficacy of tetracaine-adrenaline-cocaine topical anesthetic without tetracaine for facial laceration repair in children . Pediatrics . 1990;86:856-857.
22.
Smith SM, Barry RC.  A comparison of three formulations of TAC (tetracaine, adrenalin, cocaine) for anesthesia of minor lacerations in children . Pediatr Emerg Care . 1990;6:266-270.Article
23.
Bonadio WA, Wagner V.  Adrenaline-cocaine gel topical anesthetic for dermal laceration repair in children . Ann Emerg Med . 1992;21:1435-1438.Article
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