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Topical anaesthesia for minor lacerations: MAC versus TAC
Author(s) -
Kuhn Marie,
Rossi Simone O P,
Plummer John L,
Raftos Jeremy
Publication year - 1996
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.1996.tb94188.x
Subject(s) - medicine , anesthesia , tetracaine , general anaesthesia , adverse effect , incidence (geometry) , prospective cohort study , bupivacaine , topical anesthetic , surgery , emergency department , lidocaine , physics , psychiatry , optics
Objective: To determine whether a solution of bupivacaine (Marcain [Astra]), adrenaline and cocaine (MAC) is as safe and effective as tetracaine, adrenaline and cocaine (TAC) as topical anaesthesia for wound suturing. Design: Double‐blind, randomised, prospective trial. Setting: Emergency departments of two tertiary referral hospitals (one specialising in paediatric care) in Adelaide, South Australia, between February 1992 and April 1994. Participants: 181 patients, aged six or older, with simple dermal lacerations less than 5 mm deep, not involving mucous membranes or areas with end‐arterial blood supply. Interventions: Patients received a weight‐adjusted dose of either MAC or TAC. Outcome measures: Needle‐prick testing of wound for pain before suturing, pain ratings by patients and physicians during suturing, signs and symptoms of cocaine toxicity, wound complications and patient preference for topical anaesthesia. Results: Topical anaesthesia was adequate for suturing in 73% of patients (83% of those with head wounds and 56% of those with extremity wounds). MAC and TAC did not differ significantly in efficacy overall or by wound location. Pain ratings from patients treated with MAC and TAC were comparable, as was patient acceptance of topical anaesthesia (77%, MAC; 81%, TAC) and the incidence of adverse effects (4% infection rate overall). Conclusions: Topical anaesthesia is a safe and effective means of anaesthetising selected lacerations for suturing. As we found no significant differences in either the efficacy or safety of the two solutions, we believe that MAC can be substituted for the less readily available TAC whenever expedient.