title: History of T-cain: a local anesthetic developed and manufactured in Japan.
abstract: In many anesthesia textbooks written in English, lidocaine, tetracaine, bupivacaine, ropivacaine, and chloroprocaine are listed as useful local anesthetics for spinal anesthesia. In contrast, T-cain is not included in these lists, even though it has been reported to be suitable for spinal anesthesia in Japan. T-cain was developed as a local anesthetic in the early 1940s by Teikoku Kagaku Sangyo Inc. in Itami, Japan, by replacing a methyl group on tetracaine (Pantocaine(®)) with an ethyl group. T-cain was clinically approved for topical use in Japan in November 1949, and a mixture of dibucaine and T-cain (Neo-Percamin S(®)) was approved for spinal use in May 1950. Simply because of a lack of foreign marketing strategy, T-cain has never attracted global attention as a local anesthetic. However, in Japan, T-cain has been used topically or intrathecally (as Neo-Percamin S(®)) for more than 60 years. Other than the side effects generally known for all local anesthetics, serious side effects have not been reported for T-cain. In fact, several articles have reported that T-cain decreases the neurotoxicity of dibucaine. In this historical review, the characteristics of T-cain and its rise to become a major spinal anesthetic in Japan are discussed.
authors: Intensive Care Unit, Gunma University Hospital, 3-39-22, Showa, Maebashi, Gunma, 371-8511, Japan. to-be@f3.dion.ne.jp.
authors: Masaru
authors: M
authors: Tobe
authors: Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
authors: Shigeru
authors: S
authors: Saito
mesh_terms: D000287:Administration, Topical; D000772:Anesthesia, Local / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000737:chemistry; D003992:Dibucaine / Q000008:administration & dosage / Q000737:chemistry; D006801:Humans; D007564:Japan; D020258:Neurotoxicity Syndromes / Q000517:prevention & control; D013748:Tetracaine / Q000737:chemistry
chemical_list: D000779:Anesthetics, Local; D013748:Tetracaine; D003992:Dibucaine
keywords: Dibucaine; Local anesthetic; Spinal anesthesia; T-cain; Topical anesthesia