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, adrenaline, and cocaine) solution for suturing uncomplicated extremity wounds. Methods: We conducted a prospective, single-blind, randomized trial in a convenience...
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| Veröffentlicht in: | Annals of emergency medicine 1997-08, Vol.30 (2), p.163-166 |
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| creator | Zempsky, William T Karasic, Raymond B |
| description | Study objective: To compare the anesthetic efficacy of EMLA (eutectic mixture of local anesthetics) cream with that of TAC (tetracaine, adrenaline, and cocaine) solution for suturing uncomplicated extremity wounds.
Methods: We conducted a prospective, single-blind, randomized trial in a convenience sample of 32 children, ages 5 to 18 years, who required repair of an extremity laceration. Eligible wounds were less than 5 cm long and less than 12 hours old. Lacerations involving digits, deep tissues, or musculature were excluded. Patients receiving medications that predisposed them to methemoglobinemia were also excluded. Lacerations 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 supplemental lidocaine was required, as judged by a suturing caregiver who was blinded to the anesthetic used.
Results: The two groups were similar with regard to age, sex, wound length and depth, and wound age. EMLA-treated wounds were repaired without supplemental anesthesia more often than TAC-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 minutes,
P |
| doi_str_mv | 10.1016/S0196-0644(97)70136-7 |
| format | Article |
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Methods: We conducted a prospective, single-blind, randomized trial in a convenience sample of 32 children, ages 5 to 18 years, who required repair of an extremity laceration. Eligible wounds were less than 5 cm long and less than 12 hours old. Lacerations involving digits, deep tissues, or musculature were excluded. Patients receiving medications that predisposed them to methemoglobinemia were also excluded. Lacerations 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 supplemental lidocaine was required, as judged by a suturing caregiver who was blinded to the anesthetic used.
Results: The two groups were similar with regard to age, sex, wound length and depth, and wound age. EMLA-treated wounds were repaired without supplemental anesthesia more often than TAC-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 minutes,
P<.01). Dehiscence occurred in one wound in each group; no wound infections were observed.
Conclusion: EMLA appears to be superior to TAC for anesthesia of simple extremity lacerations in that those wounds treated with EMLA required supplemental anesthesia less often. EMLA required approximately 1 hour to cause optimal anesthesia in open wounds. Protocols should be developed to allow efficient use of EMLA for anesthesia of extremity lacerations in the ED. [Zempsky WT, Karasic RB: EMLA versus TAC for topical anesthesia of extremity wounds in children.
Ann Emerg Med August 1997;30:163-166.]</description><identifier>ISSN: 0196-0644</identifier><identifier>EISSN: 1097-6760</identifier><identifier>DOI: 10.1016/S0196-0644(97)70136-7</identifier><identifier>PMID: 9250639</identifier><identifier>CODEN: AEMED3</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Adolescent ; Anesthesia ; Anesthesia, Local - methods ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Anesthetics, Combined - therapeutic use ; Anesthetics, Local - therapeutic use ; Arm Injuries - therapy ; Biological and medical sciences ; Child ; Child, Preschool ; Cocaine - therapeutic use ; Drug Combinations ; Epinephrine - therapeutic use ; Female ; Humans ; Leg Injuries - therapy ; Local anesthesia. Pain (treatment) ; Male ; Medical sciences ; Prospective Studies ; Single-Blind Method ; Sutures ; Tetracaine - therapeutic use ; Treatment Outcome ; Vasoconstrictor Agents - therapeutic use ; Wounds, Penetrating - surgery</subject><ispartof>Annals of emergency medicine, 1997-08, Vol.30 (2), p.163-166</ispartof><rights>1997 Mosby, Inc.</rights><rights>1997 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c467t-f545bd61712f11a890f1718dc2b8d80f9b51dbd2e6aab0229f1757e3c8b0099e3</citedby><cites>FETCH-LOGICAL-c467t-f545bd61712f11a890f1718dc2b8d80f9b51dbd2e6aab0229f1757e3c8b0099e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/S0196-0644(97)70136-7$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,45974</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2769735$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9250639$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zempsky, William T</creatorcontrib><creatorcontrib>Karasic, Raymond B</creatorcontrib><title>EMLA Versus TAC for Topical Anesthesia of Extremity Wounds in Children</title><title>Annals of emergency medicine</title><addtitle>Ann Emerg Med</addtitle><description>Study objective: To compare the anesthetic efficacy of EMLA (eutectic mixture of local anesthetics) cream with that of TAC (tetracaine, adrenaline, and cocaine) solution for suturing uncomplicated extremity wounds.
Methods: We conducted a prospective, single-blind, randomized trial in a convenience sample of 32 children, ages 5 to 18 years, who required repair of an extremity laceration. Eligible wounds were less than 5 cm long and less than 12 hours old. Lacerations involving digits, deep tissues, or musculature were excluded. Patients receiving medications that predisposed them to methemoglobinemia were also excluded. Lacerations 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 supplemental lidocaine was required, as judged by a suturing caregiver who was blinded to the anesthetic used.
Results: The two groups were similar with regard to age, sex, wound length and depth, and wound age. EMLA-treated wounds were repaired without supplemental anesthesia more often than TAC-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 minutes,
P<.01). Dehiscence occurred in one wound in each group; no wound infections were observed.
Conclusion: EMLA appears to be superior to TAC for anesthesia of simple extremity lacerations in that those wounds treated with EMLA required supplemental anesthesia less often. EMLA required approximately 1 hour to cause optimal anesthesia in open wounds. Protocols should be developed to allow efficient use of EMLA for anesthesia of extremity lacerations in the ED. [Zempsky WT, Karasic RB: EMLA versus TAC for topical anesthesia of extremity wounds in children.
Ann Emerg Med August 1997;30:163-166.]</description><subject>Adolescent</subject><subject>Anesthesia</subject><subject>Anesthesia, Local - methods</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Anesthetics, Combined - therapeutic use</subject><subject>Anesthetics, Local - therapeutic use</subject><subject>Arm Injuries - therapy</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Cocaine - therapeutic use</subject><subject>Drug Combinations</subject><subject>Epinephrine - therapeutic use</subject><subject>Female</subject><subject>Humans</subject><subject>Leg Injuries - therapy</subject><subject>Local anesthesia. Pain (treatment)</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Prospective Studies</subject><subject>Single-Blind Method</subject><subject>Sutures</subject><subject>Tetracaine - therapeutic use</subject><subject>Treatment Outcome</subject><subject>Vasoconstrictor Agents - therapeutic use</subject><subject>Wounds, Penetrating - surgery</subject><issn>0196-0644</issn><issn>1097-6760</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1997</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkMtKAzEUhoMotV4eQchCRBejyVySyUqGUi9QcWHVZcgkJxiZztRkRuzbm9rSrasc-L9z8vMhdEbJNSWU3bwQKlhCWJ5fCn7FCc1YwvfQmBLBE8YZ2UfjHXKIjkL4JISIPKUjNBJpQVgmxuhu-jSr8Bv4MAQ8rybYdh7Pu6XTqsFVC6H_gOAU7iye_vQeFq5f4fduaE3ArsWTD9cYD-0JOrCqCXC6fY_R6910PnlIZs_3j5Nqluic8T6xRV7UhlFOU0upKgWxcS6NTuvSlMSKuqCmNikwpWqSpiLGBYdMl3WsLiA7Rhebu0vffQ2xnVy4oKFpVAvdECQXlLO8zCJYbEDtuxA8WLn0bqH8SlIi1_7knz-5liMFl3_-JI97Z9sPhnoBZre1FRbz822uQlRkvWq1Czss5UzwrIjY7QaDKOPbgZdBO2g1GOdB99J07p8iv1hjiqw</recordid><startdate>19970801</startdate><enddate>19970801</enddate><creator>Zempsky, William T</creator><creator>Karasic, Raymond B</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19970801</creationdate><title>EMLA Versus TAC for Topical Anesthesia of Extremity Wounds in Children</title><author>Zempsky, William T ; Karasic, Raymond B</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c467t-f545bd61712f11a890f1718dc2b8d80f9b51dbd2e6aab0229f1757e3c8b0099e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1997</creationdate><topic>Adolescent</topic><topic>Anesthesia</topic><topic>Anesthesia, Local - methods</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Anesthetics, Combined - therapeutic use</topic><topic>Anesthetics, Local - therapeutic use</topic><topic>Arm Injuries - therapy</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Cocaine - therapeutic use</topic><topic>Drug Combinations</topic><topic>Epinephrine - therapeutic use</topic><topic>Female</topic><topic>Humans</topic><topic>Leg Injuries - therapy</topic><topic>Local anesthesia. Pain (treatment)</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Prospective Studies</topic><topic>Single-Blind Method</topic><topic>Sutures</topic><topic>Tetracaine - therapeutic use</topic><topic>Treatment Outcome</topic><topic>Vasoconstrictor Agents - therapeutic use</topic><topic>Wounds, Penetrating - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zempsky, William T</creatorcontrib><creatorcontrib>Karasic, Raymond B</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zempsky, William T</au><au>Karasic, Raymond B</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>EMLA Versus TAC for Topical Anesthesia of Extremity Wounds in Children</atitle><jtitle>Annals of emergency medicine</jtitle><addtitle>Ann Emerg Med</addtitle><date>1997-08-01</date><risdate>1997</risdate><volume>30</volume><issue>2</issue><spage>163</spage><epage>166</epage><pages>163-166</pages><issn>0196-0644</issn><eissn>1097-6760</eissn><coden>AEMED3</coden><abstract>Study objective: To compare the anesthetic efficacy of EMLA (eutectic mixture of local anesthetics) cream with that of TAC (tetracaine, adrenaline, and cocaine) solution for suturing uncomplicated extremity wounds.
Methods: We conducted a prospective, single-blind, randomized trial in a convenience sample of 32 children, ages 5 to 18 years, who required repair of an extremity laceration. Eligible wounds were less than 5 cm long and less than 12 hours old. Lacerations involving digits, deep tissues, or musculature were excluded. Patients receiving medications that predisposed them to methemoglobinemia were also excluded. Lacerations 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 supplemental lidocaine was required, as judged by a suturing caregiver who was blinded to the anesthetic used.
Results: The two groups were similar with regard to age, sex, wound length and depth, and wound age. EMLA-treated wounds were repaired without supplemental anesthesia more often than TAC-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 minutes,
P<.01). Dehiscence occurred in one wound in each group; no wound infections were observed.
Conclusion: EMLA appears to be superior to TAC for anesthesia of simple extremity lacerations in that those wounds treated with EMLA required supplemental anesthesia less often. EMLA required approximately 1 hour to cause optimal anesthesia in open wounds. Protocols should be developed to allow efficient use of EMLA for anesthesia of extremity lacerations in the ED. [Zempsky WT, Karasic RB: EMLA versus TAC for topical anesthesia of extremity wounds in children.
Ann Emerg Med August 1997;30:163-166.]</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>9250639</pmid><doi>10.1016/S0196-0644(97)70136-7</doi><tpages>4</tpages></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adolescent Anesthesia Anesthesia, Local - methods Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anesthetics, Combined - therapeutic use Anesthetics, Local - therapeutic use Arm Injuries - therapy Biological and medical sciences Child Child, Preschool Cocaine - therapeutic use Drug Combinations Epinephrine - therapeutic use Female Humans Leg Injuries - therapy Local anesthesia. Pain (treatment) Male Medical sciences Prospective Studies Single-Blind Method Sutures Tetracaine - therapeutic use Treatment Outcome Vasoconstrictor Agents - therapeutic use Wounds, Penetrating - surgery |
| title | EMLA Versus TAC for Topical Anesthesia of Extremity Wounds in Children |
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