TOPICAL ANESTHESIA FOR MINOR LACERATIONS - MAC VERSUS TAC

Objective: To determine whether a solution of bupivacaine (Marcain [As tra]), adrenaline and cocaine (MAC) is as safe and effective as tetrac aine, adrenaline and cocaine (TAG) as topical anaesthesia for wound su turing. Design: Double-blind, randomised, prospective trial. Setting: Emergency departments of two tertiary referral hospitals (one speciali sing in paediatric care) in Adelaide, South Australia, between Februar y 1992 and April 1994. Participants: 181 patients, aged six or older, with simple dermal lacerations less than 5 mm deep, not involving muco us membranes or areas with end-arterial blood supply. Interventions: P atients received a weight-adjusted dose of either MAC or TAG. Outcome measures: Needle-prick testing of wound for pain before suturing, pain ratings by patients and physicians during suturing, signs and symptom s of cocaine toxicity, wound complications and patient preference for topical anaesthesia. Results: Topical anaesthesia was adequate for sut uring in 73% of patients (83% of those with head wounds and 56% of tho se with extremity wounds). MAC and TAC did not differ significantly in efficacy overall or by wound location. Pain ratings from patients tre ated with MAC and TAC were comparable, as was patient acceptance of to pical anaesthesia (77%, MAC; 81%, TAG) and the incidence of adverse ef fects (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 effica cy or safety of the two solutions, we believe that MAC can be substitu ted for the less readily available TAC whenever expedient.