Two recent articles in Annals have discussed the efficacy and complications of TAC, as topical anesthetic used to facilitate repair of minor lacerations (Pryor et al: "Local anesthesia in minor lacerations: Topical TAG versus lidocaine infiltration," November 1980i9:568-571; and Barker et al: "Damage to tissue defenseS by a topical anesthetic agent," June 1982;11:307-310.) TAC is a solution containing tetracaine (0.5%), adrenalin (0.05%), and cocaine (11.8%).
Two of the recommendations for the use of TAC are: 1) to achieve active bleeding prior to the placement of TAC in the laceration, and 2) to have the TAC applied with firm pressure by nursing personnel for five to ten minutes. The second recommendation has caused some physicians to refrain from using TAC, as they feel this is not an efficient utilization of nursing personnel's time.
We designed a small study to test the validity of these recommendations. We prospectively studied 31 children 12 years of age or younger. Children with lacerations less than 6 cm in length were included in the study. When children who met these criteria presented to the emergency department they were randomly assigned to one of two groups. In Group A, the laceration was stroked with a saline-soaked sterile gauze until bleeding occurred. A predetermined amount of TAC was applied to the laceration (5 cc of TAC if the laceration was less than 3 cm in length, and 10 cc if the laceration was 3 to 6 cm in length). The TAC was applied by placing it on a piece of sterile gauze which was held in the laceration with firm pressure for a minimum of five minutes by a member of the nursing staff. In Group B, the proper amount of TAC was applied to a piece of gauze and held in the laceration for a minimum of five minutes by the person accompanying the child to the emergency department. No active bleeding was induced in Group B.
The results of the study are shown (Table ).
The findings of this study suggest the following: 1) TAC