Author:
Marie Kuhn, MD, Flinders
Medical Centre
Bedford Park South Australia 5042
Telephone (08) 204
5511
International 618 204 5511
To determine whether a solution of bupivacaine, adrenaline and cocaine (MAC) is as safe and effective as TAC in providing topical anesthesia for suturing.
Double-blinded, randomized, prospective trial.
Two University Teaching Hospitals.
Type of participants: 181 patients, aged 5 or older, with selected lacerations not involving mucous membranes or areas with end-arterial blood supply.
Patients received a weight-adjusted dose of either MAC or TAC. If topical anesthesia was deemed inadequate, it was supplemented with injected local anesthesia. While being sutured, patients rated their discomfort using standardized pain scales. Patients were monitored for signs and symptoms of Cocaine toxicity and were followed for evidence of wound complications.
Topical anesthesia was sufficient to allow suturing in 73.3% of our patients including 83.3% of those with head wounds and 56.1% of those with extremity wounds. There was no difference in the efficacy of MAC or TAC overall (p=0.87), or by wound location subsets. The pain ratings from patients treated with MAC and TAC were comparable. Patient acceptance of topical anesthesia, and the incidence of adverse effects, were equivalent in the MAC- and TAC-treated groups.
Topical anesthesia is a safe and effective means of anesthetizing selected lacerations prior to suturing. As we found no significant differences in either the efficacy or safety of the two solutions tested, we believe that MAC can be substituted for TAC whenever it is expedient to do so.
August 10, 1994
Dear Dr. Wong,
We selected your Faces Scale based upon the recommendation of a physician who specializes in Pain Management. We found the scale easy to explain and the children appeared to enjoy marking the faces (some actually decorated the chosen face with hair, beard, glasses, etc) I believe that our data would indicate that your Faces Scale is as valid and reliable in children aged 6-12 years, as is the Visual Analog Scale in adults.
Marie Kuhn, M.D.
FAX (618) 204-5879
March 15, 2002
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