Local anesthesia in pediatric patients: topical TAC versus lidocaine

Lacerations requiring sutures are a common surgical emergency in children. Traditional anesthesia prior to suturing has been intradermal lidocaine. TAC (0.5% tetracaine, 1:2,000 adrenalin, 11.8% cocaine) is a topically applied anesthetic. A randomized, placebo-controlled, double-blind clinical study was conducted to test the hypothesis that topical TAC and intradermal lidocaine are equally efficacious with respect to patient compliance with the suturing process, ie, anesthetic application and placement of sutures, and development of wound complications. Patients less than 18 years old, with lacerations 5 cm or less in length, located in well vascularized, nonmucous membrane areas were included. Patients were entered into the intradermal or topical groups; the intradermal group received lidocaine and the topical group was randomized to receive either TAC or placebo. One hundred fifty-one patients were enrolled in the study. There was no significant difference in the rates of successful initial anesthesia with TAC (89%) and lidocaine (79%). TAC was significantly better (P less than .002) with regard to patient compliance with the suturing process than lidocaine or placebo. Seventeen percent of patients who received placebo had initial anesthesia. These results suggest that TAC, when applied correctly, may be the preferred anesthetic for laceration repair in children.