Clinical comparison of TAC anesthetic solutions with and without cocaine

Two preparations of a topical anesthetic solution were compared with regard to their relative effectiveness, the incidence of side effects, and the occurrence of wound infection. Solution A contained tetracaine 0.5%, adrenalin 1:2,000, and cocaine 11.8%; solution B contained the same amounts of tetracaine and adrenalin but no cocaine. Children less than 10 years old who presented with facial or scalp lacerations were randomized into the A and B groups. Solution A was significantly more effective (P = .01) in producing adequate anesthesia; 8.9% of these patients required supplemental xylocaine injection, compared with 27.5% of B patients. Clinical evidence of wound infection, manifested by erythema at the time of suture removal, occurred in 7% of group A patients; none of the group B patients showed these signs. Drowsiness or excitability following the use of solutions A and B occurred in 10.7% and 7.8%, respectively. There was no convincing evidence, however, that these were causally related, nor was there any statistical correlation. Because of the effectiveness of cocaine-based topical anesthetics in the pediatric population and the relatively low incidence of side effects, including wound infection, it is recommended that topical anesthesia for dermal laceration repair be considered as an alternative to injectable xylocaine.