Clinical comparison of TAC Anesthetic solutions with and without cocaine (1985)

FRANÇAIS :
Les propriétés de 2 solutions anesthésiques percutanées sont comparées chez une centaine d'enfants de moins de 10 ans présentant des plaies à suturer. L'une des solutions contient de la tétracaïne et de l'adrénaline, l'autre contient en plus de la cocaïne. La solution contenant la cocaïne procure une anesthésie de bien meilleure qualité, mais son usage s'accompagne de façon statistiquement significative d' infections ou de disjonctions de la suture. Par ailleurs, on relève davantage d'autres effets secondaires tels que l'excitabilité et la somnolence, mais l'augmentation de ces autres effets secondaires n'est pas statistiquement significative. Au cours de la discussion, les auteurs s'interrogent sur l'existence éventuelle de biais qui rendraient mieux compte que l'utilisation de cocaïne des effets secondaires statistiquement significatifs. Malgré un coût d'utilisation plus élevé, ils se déclarent satisfaits de l'utilisation de la solution contenant la cocaïne, en raison du caractère bien moins douloureux et traumatisant des soins.
ENGLISH:
Two preparations of a topical anesthetic solution were compared with regard to their relative effectiveness, the incidence of side effects, and the occurrence of wound infection. Solution A contained tetracaine 0.5%, adrenalin 1:2,000, and cocaine 11.8%; solution B contained the same amounts of tetracaine and adrenalin but no cocaine. Children less than 10 years old who presented with facial or scalp lacerations were randomized into the A and B groups. Solution A was significantly more effective (P = .01) in producing adequate anesthesia; 8.9% of these patients required supplemental xylocaine injection, compared with 27.5% of B patients. Clinical evidence of wound infection, manifested by erythema at the time of suture removal, occurred in 7% of group A patients; none of the group B patients showed these signs. Drowsiness or excitability following the use of solutions A and B occurred in 10.7% and 7.8%, respectively. There was no convincing evidence, however, that these were causally related, nor was there any statistical correlation. Because of the effectiveness of cocaine-based topical anesthetics in the pediatric population and the relatively low incidence of side effects, including wound infection, it is recommended that topical anesthesia for dermal laceration repair be considered as an alternative to injectable xylocaine.