title: Topical anaesthesia for minor lacerations: MAC versus TAC.
abstract: OBJECTIVE
  To determine whether a solution of bupivacaine Marcain [Astra]), adrenaline and cocaine (MAC) is as safe and effective as tetracaine, adrenaline and cocaine (TAC) as topical anaesthesia for wound suturing.
  
  
  METHODS
  Double-blind, randomised, prospective trial.
  
  
  METHODS
  Emergency departments of two tertiary referral hospitals (one specialising in paediatric care) in Adelaide, South Australia, between February 1992 and April 1994.
  
  
  METHODS
  181 patients, aged six or older, with simple dermal lacerations less than 5mm deep, not involving mucous membranes or areas with end-arterial blood supply.
  
  
  METHODS
  Patients received a weight-adjusted dose of either MAC or TAC.
  
  
  METHODS
  Needle-prick testing of wound for pain before suturing, pain ratings by patients and physicians during suturing, signs and symptoms of cocaine toxicity, wound complications and patient preference for topical anaesthesia.
  
  
  RESULTS
  Topical anaesthesia was adequate for suturing in 73% of patients (83% or those with head wounds and 56% of those with extremity wounds). MAC and TAC did not differ significantly in efficacy overall or by wound location. Pain ratings from patients treated with MAC and TAC were comparable, as was patients acceptance of topical anesthesia (77%, MAC; 81%, TAC) and the incidence of adverse effects (4% infection rate overall).
  
  
  CONCLUSIONS
  Topical anesthesia is a safe and effective means of anaesthetising selected lacerations for suturing. As we found no significant differences in either the efficacy or safety of the two solutions, we believe that MAC can be substituted for the less readily available TAC whenever expedient.
authors.affiliation: Emergency Department, Flinders Medical Centre, Adelaide, SA Australia.
authors.forename: M
authors.initials: M
authors.lastname: Kuhn
authors.forename: S O
authors.initials: SO
authors.lastname: Rossi
authors.forename: J L
authors.initials: JL
authors.lastname: Plummer
authors.forename: J
authors.initials: J
authors.lastname: Raftos
mesh_terms: D000293:Adolescent; D000772:Anesthesia, Local; D000779:Anesthetics, Local; D002045:Bupivacaine; D002648:Child; D003042:Cocaine; D062109:Dermatologic Surgical Procedures; D004837:Epinephrine; D006801:Humans; D012867:Skin / Q000293:injuries*; D017695:Soft Tissue Injuries / Q000601:surgery*; D013537:Sutures; D013748:Tetracaine; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D013748:Tetracaine; D003042:Cocaine; D002045:Bupivacaine; D004837:Epinephrine