EMLA VERSUS TAC FOR TOPICAL ANESTHESIA OF EXTREMITY WOUNDS IN CHILDREN

Study objective: To compare the anesthetic efficacy of EMLA (eutectic mixture of local anesthetics) cream with that of TAC (tetracaine, adre naline, and cocaine) solution for suturing uncomplicated extremity wou nds. Methods: We conducted a prospective, single-blind, randomized tri al in a convenience sample of 32 children, ages 5 to 18 years, who req uired repair of an extremity laceration. Eligible wounds were less tha n 5 cm long and less than 12 hours old. Lacerations involving digits, deep tissues, or musculature were excluded. Patients receiving medicat ions that predisposed them to methemoglobinemia were also excluded. La cerations were treated with TAC .1 mL/kg (maximum, 3.0 mL) or EMLA .15 g/kg (maximum, 5.0 g). Anesthesia was assessed every 10 minutes. TAC and EMLA were allowed to remain on the wounds for a maximum of 30 and 60 minutes, respectively. Anesthesia was deemed successful if no suppl emental lidocaine was required, as judged by a suturing caregiver who was blinded to the anesthetic used. Results: The two groups were simil ar with regard to age, sex, wound length and depth, and wound age. EML A-treated wounds were repaired without supplemental anesthesia more of ten than TAG-treated wounds: 13 of 16 (85%) versus 7 of 16 (45%, P=.03 ). More time was required for EMLA to cause anesthesia (55 versus 29 m inutes, P<.01). Dehiscence occurred in one wound in each group; no wou nd infections were observed. Conclusion: EMLA appears to be superior t o TAC for anesthesia of simple extremity lacerations in that those wou nds treated with EMLA required supplemental anesthesia less often. EML A required approximately 1 hour to cause optimal anesthesia in open wo unds. Protocols should be developed to allow efficient use of EMLA for anesthesia of extremity lacerations in the ED.