Anderson A B, Colecchi C, Baronoski R, DeWitt T G
Division of General and Community Pediatrics, University of Massahusetts Medical Center, Worcester.
Ann Emerg Med. 1990 May;19(5):519-22. doi: 10.1016/s0196-0644(05)82182-1.
Lacerations requiring sutures are a common surgical emergency in children. Traditional anesthesia prior to suturing has been intradermal lidocaine. TAC (0.5% tetracaine, 1:2,000 adrenalin, 11.8% cocaine) is a topically applied anesthetic. A randomized, placebo-controlled, double-blind clinical study was conducted to test the hypothesis that topical TAC and intradermal lidocaine are equally efficacious with respect to patient compliance with the suturing process, ie, anesthetic application and placement of sutures, and development of wound complications. Patients less than 18 years old, with lacerations 5 cm or less in length, located in well vascularized, nonmucous membrane areas were included. Patients were entered into the intradermal or topical groups; the intradermal group received lidocaine and the topical group was randomized to receive either TAC or placebo. One hundred fifty-one patients were enrolled in the study. There was no significant difference in the rates of successful initial anesthesia with TAC (89%) and lidocaine (79%). TAC was significantly better (P less than .002) with regard to patient compliance with the suturing process than lidocaine or placebo. Seventeen percent of patients who received placebo had initial anesthesia. These results suggest that TAC, when applied correctly, may be the preferred anesthetic for laceration repair in children.
需要缝合的裂伤是儿童常见的外科急症。传统的缝合前麻醉方法是皮内注射利多卡因。TAC（0.5%丁卡因、1:2000肾上腺素、11.8%可卡因）是一种局部应用的麻醉剂。进行了一项随机、安慰剂对照、双盲临床研究，以检验以下假设：局部应用TAC和皮内注射利多卡因在患者对缝合过程（即麻醉剂应用和缝线放置）的依从性以及伤口并发症的发生方面同样有效。纳入年龄小于18岁、裂伤长度为5 cm或更短、位于血运良好的非黏膜区域的患者。患者被分为皮内注射组或局部应用组；皮内注射组接受利多卡因，局部应用组随机接受TAC或安慰剂。151名患者参与了该研究。TAC（89%）和利多卡因（79%）的首次麻醉成功率无显著差异。在患者对缝合过程的依从性方面，TAC显著优于利多卡因或安慰剂（P小于0.002）。接受安慰剂的患者中有17%实现了首次麻醉。这些结果表明，正确应用时，TAC可能是儿童裂伤修复的首选麻醉剂。
