We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Efficacy of Topical Anesthesia in Children

Robert J. Vinci, MD; Susan S. Fish, Pharm D
Arch Pediatr Adolesc Med. 1996;150(5):466-469. doi:10.1001/archpedi.1996.02170300020005.
Text Size: A A A
Published online


Objectives:  To compare the efficacy of three formulations of a topical anesthetic solution composed of various concentrations of tetracaine hydrochloride, adrenaline (epinephrine), and cocaine hydrochloride (TAC), and to compare the cost of the topical anesthetic solutions with the cost of lidocaine infiltration.

Design:  Randomized, double-blind clinical trial.

Setting:  Urban pediatric emergency department.

Participants:  One hundred fifty-six children 3 to 18 years of age and older requiring topical anesthesia for suturing of lacerations.

Intervention:  Children received 3 mL of one of the following study solutions: TAC 1 consisting of 0.5% tetracaine, 1:2000 dilution of adrenaline, 11.8% cocaine; TAC 2 that contained 1% tetracaine, 1:2000 dilution of adrenaline, 4% cocaine; or TAC 3 made up of 1% tetracaine and 4% cocaine, without adrenaline.

Measurements or Main Results:  Patients were randomized to group 1 (n=49), group 2 (n=49), or group 3 (n=58), and received TAC 1, TAC 2, or TAC 3, respectively. Patients in the three study groups were similar for age, gender, anatomic location and length of the laceration, and history of sutures or use of topical anesthesia. Based on the physician assessment of achievement of complete, partial, or no anesthesia, solutions containing 11.8% cocaine (TAC 1) and 4% cocaine with adrenaline (TAC 2) were more likely to produce complete anesthesia than the solution with 4% cocaine without adrenaline (TAC 3) (P<.001, χ2). This difference was only noted when the laceration involved the face or scalp. A second dose of the TAC 3 solution was more often required to produce anesthesia when compared with the other two study drugs (P<.003, χ2). The final cost to produce 3 mL of the study drugs, including the vials, was $16.39 for TAC 1, $8.67 for TAC 2, and $8.41 for TAC 3.

Conclusions:  The application of a TAC solution containing 4% cocaine is as effective as a TAC solution containing 11.8% cocaine. Use of the 4% solution decreases the cost of the agent. Adrenaline is a necessary ingredient in the anesthetic solution.(Arch Pediatr Adolesc Med. 1996;150:466-469)


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.