Method of applying topical anesthetics to oral lacerations - Tips from Other Journals

Author: Richard Sadovsky
Date: Feb 15, 1997

The topical anesthetic containing tetracaine, adrenaline and cocaine (TAC) is considered safe and effective and is commonly used during repair of dermal lacerations in children. Painless application and lack of distortion of local architecture are marked advantages over the use of lidocaine infiltration. However, there have been case reports of serious adverse reactions in children after oral application of lidocaine and TAC. Bonadio studied the safety and efficacy of a technique used for applying TAC to minor oral lacerations in children.

The technique was used in 22 children older than five years of age with lacerations less than 2 cm in length requiring single-layer closure. A two-drop dose of TAC containing 0.5 mg of tetracaine and 12 mg of cocaine was administered via a cotton-tipped applicator that was placed in contact with the wound cavity and perimeter for up to five minutes. Efforts were made to prevent swallowing of the medication. Pain response during suturing was measured objectively, and children were observed for possible adverse reactions, including drowsiness, excitability, dyspnea, seizure, urticaria or cardiac dysrhythmia.

A total of 41 (91 percent) of 45 full sutures were placed without pain. None of the patients required supplemental lidocaine infiltration. No adverse reactions were noted either in the emergency department or during telephone follow-up.

The authors conclude that the anesthetic efficacy of TAC in oral lesions is as good as that reported for dermal lesions. They recommend use of a two-drop dose administered with a cotton-tipped applicator under direct physician supervision.

Bonadio WA. Safe and effective method for application of tetracaine, adrenaline, and cocaine to oral lacerations. Ann Emerg Med 1996;28:396-8.

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