Topical anaesthesia for minor lacerations: MAC versus TAC

Area of Science:

• Emergency Medicine
• Anesthesiology
• Wound Care

Background:

• Topical anesthesia is crucial for wound closure.
• Tetracaine, adrenaline, and cocaine (TAC) is a common anesthetic, but alternatives are sought.
• Bupivacaine, adrenaline, and cocaine (MAC) offers a potential substitute.

Purpose of the Study:

• To compare the safety and efficacy of MAC versus TAC for topical anesthesia in wound suturing.
• To evaluate patient and physician pain ratings, adverse effects, and patient preference.

Main Methods:

• A double-blind, randomized, prospective trial involving 181 patients aged six and older with simple dermal lacerations.
• Patients received either MAC or TAC, with outcomes assessed via needle-prick testing, pain ratings, and monitoring for toxicity and complications.
• Data collected included pain before and during suturing, patient/physician ratings, adverse events, and anesthetic preference.

Main Results:

• Topical anesthesia was adequate for 73% of patients, with no significant difference in efficacy between MAC and TAC.
• Pain ratings and patient acceptance were comparable between the two anesthetic solutions (77% MAC, 81% TAC).
• The overall incidence of adverse effects was low, with a 4% infection rate.

Conclusions:

• Topical anesthesia, including MAC and TAC, is safe and effective for selected lacerations.
• MAC can be substituted for TAC when expedient, as no significant differences in efficacy or safety were observed.
• This finding supports the use of MAC as a viable alternative for topical wound anesthesia.