Tetracaine-adrenaline-cocaine Research Articles

Prilocaine-phenylephrine and bupivacaine-phenylephrine topical anesthetics compared with tetracaine-adrenaline-cocaine during repair of lacerations

The effectiveness of two new topical anesthetics that do not contain cocaine (prilocaine-phenylephrine and bupivacaine-phenylephrine) was compared with that of tetracaine-adrenaline-cocaine (TAC) during laceration repair in children. This study was a prospective, randomized, double-blind trial conducted in the emergency department of a large children's hospital. Participants were 180 children 1 year of age or older with a laceration 5 cm or less in length that required suturing. Pain felt during suturing was scored by suture technicians, research assistants, parents, and patients 5 years of age and older using a visual analogue scale (VAS). There was no statistical difference demonstrated between the effectiveness of prilocaine-phenylephrine and that of TAC for any of the observer groups. A statistically significant difference was seen among anesthetics when comparing VAS scores of research assistants ( P = .002), suture technicians ( P = .006), and parents ( P = .03), but not when comparing VAS ratings of patients ( P = .07). Based on Tukey's post hoc test, these statistically significant differences were between TAC and bupivacaine-phenylephrine. When power analyses were performed using α = 0.05 and β = 0.20, it was possible to detect a difference of 1.3 VAS units for each rater group. In conclusion, this study demonstrated the effectiveness and safety of prilocaine-phenylephrine and bupivacaine-phenylephrine. Prilocaine-phenylephrine statistically outperformed bupivacaine-phenylephrine and offers an effective alternative to TAC during laceration repair in children.

Cocaine-Free Anesthetics for Pediatric Suturing

TAC (tetracaine-adrenaline-cocaine) solution for topical anesthesia has proved effective and useful for laceration repair in children, but its safety and cost have been an issue. Solutions containing cocaine can cause seizures and even death if inappropriately applied to the mucous membranes. This prospective, double-blind trial found several cheaper, …

Informed consent and parental choice of anesthesia and sedation for the repair of small lacerations in children

This study investigated the issue of informed consent by surveying parent preferences for local anesthesia and sedation in the repair of small lacerations in their children in the emergency department (ED). Of the 45 ED patients with actual lacerations receiving a suture repair, 11 requested tetracaine-adrenaline-cocaine (TAC), 25 requested infiltrated lidocaine, and 9 were not given a choice (lidocaine administered because of wound proximity to a mucous membrane site). All 45 patients preferred nonsedation over sedation. In 44 of 45 patient cases, parents preferred to be included in the medical decision-making for their children. Of the 94 non-ED cases (interviewed in private offices) with a hypothetical chin laceration, 16 preferred TAC and 78 preferred infiltrated lidocaine. Sixty-seven of 94 preferred nonsedation over sedation. In 89 of 94 patient cases, parents preferred to be included in the medical decision-making for their children. Favorable points of continuous informed consent were presented, with risks, benefits, and alternatives disclosed. From the data presented, the following conclusions were drawn: (1) parents preferred infiltrated local anesthesia more commonly than topical local anesthesia; (2) parents preferred nonsedation over sedation under the clinical circumstances described; (3) parents overwhelmingly preferred to be included in the medical decisions affecting their children.

Lidocaine Adrenaline Tetracaine Gel Versus Tetracaine Adrenaline Cocaine Gel for Topical Anesthesia in Linear Scalp and Facial Lacerations in Children 5 to 17 Years of Age

Lidocaine Adrenaline Tetracaine Gel Versus Tetracaine Adrenaline Cocaine Gel for Topical Anesthesia in Linear Scalp and Facial Lacerations in Children 5 to 17 Years of Age

Lidocaine Adrenaline Tetracaine versus Tetracaine Adrenaline Cocaine gel for topical anesthesia in linear scalp and facial lacerations in children aged 5 to 17 years.

Lidocaine Adrenaline Tetracaine versus Tetracaine Adrenaline Cocaine gel for topical anesthesia in linear scalp and facial lacerations in children aged 5 to 17 years.

Comparison of tetracaine-adrenaline-cocaine (TAC) with topical lidocaine-epinephrine (TLE): Efficacy and cost

Topical anesthesia in the form of TAC (tetracaine, adrenaline, cocaine) solution has been used for wound repair. This pilot study was designed to determine if the topical anesthesia achieved using a mixture of lidocaine (5%) and epinephrine (1:2000) (TLE) is equivalent to the topical anesthesia obtained using a solution of tetracaine (0.5%), epinephrine (1: 2000), and cocaine (10.4%) (TAC). A prospective, randomized, double-blind trial was carried out from May 1992 to August 1992 at a community-based teaching hospital Emergency Department (ED) that receives 50,000 annual visits. Patients with facial or scalp lacerations suitable for topical anesthesia presenting to the ED were included when study physicians were in attendance. Exclusion criteria included the presence of a sensory altering substance (eg, ethanol), age younger than two years, hypertension, pregnancy, allergy to any of the study's pharmacological agents, wounds greater than six hours old, grossly contaminated wounds, and wounds longer than six centimeters. Either a TAC or TLE solution was applied to lacerations before suturing. The laceration was repaired and the patient or physician evaluated the degree of pain from the procedure by using a standardized visual pain scale. A total of 35 patients were studied. Seventeen patients were in the TLE group; 18 in the TAC group. The mean ages were compared and found to be similar (P = .40) between the two test groups. The pain scale values, the diameter of tissue blanch around laceration (halo size), and the time to laceration repair from the onset of application of anesthetic were compared and no difference was shown between the TAC and TLE groups.(ABSTRACT TRUNCATED AT 250 WORDS)

T.A.C.

To the Editor.— As a pharmacist at a pediatric hospital which uses tetracaineadrenaline-cocaine (TAC), I was interested in the article by Bonadio and Wagner.1 I have often wondered about the relative anesthetic contribution of tetracaine in this arbitrarily developed extemporaneous product.2 The use of TAC in our emergency department has increased greatly during the last year, and the physicians have accepted it as a safe and effective anesthetic alternative to injections of lidocaine. As in