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Canadian Family Physician Medecin de... Oct 1998To consider topical anesthetic options available to primary care physicians, indications for their use, and efficacy and safety of these agents as supported by the... (Review)
Review
OBJECTIVE
To consider topical anesthetic options available to primary care physicians, indications for their use, and efficacy and safety of these agents as supported by the literature.
QUALITY OF EVIDENCE
Five randomized controlled trials were retrieved that compared various topical anesthetics as well as topical anesthetics versus infiltrative anesthesia.
MAIN FINDINGS
A combination of lidocaine, epinephrine, and tetracaine (LET) is currently the topical anesthetic of choice for repair of simple lacerations involving the faces and scalps of children. A promising new topical preparation is bupivacaine and epinephrine, but its efficacy must be studied in larger populations before widespread use can be advocated. Using EMLA (eutectic mixture of local anesthetics) for repair of extremity lacerations requires further study and cannot yet be recommended. Continued use of topical tetracaine, adrenaline, and cocaine (TAC) is not supported in the literature, because of its greater expense, its status as a restricted narcotic, its potential for toxicity, and better availability of an equally efficacious alternative, LET.
CONCLUSIONS
Children's simple facial and scalp lacerations can be safely repaired using topical LET gel. Physicians must adhere to recommendations to avoid mucous membrane contact and ensure appropriate dosing with these agents. Bupivacaine-epinephrine topical preparation is a promising analgesic agent that warrants further study.
Topics: Adult; Anesthetics, Combined; Anesthetics, Local; Child; Cocaine; Drug Combinations; Epinephrine; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Pain; Patient Selection; Prilocaine; Research Design; Suture Techniques; Tetracaine; Wounds and Injuries
PubMed: 9805170
DOI: No ID Found -
Academic Emergency Medicine : Official... Sep 2014
Topics: Anesthetics, Local; Corneal Injuries; Eye Injuries; Eye Pain; Female; Humans; Male; Tetracaine
PubMed: 25269591
DOI: 10.1111/acem.12468 -
Acta Paediatrica (Oslo, Norway : 1992) May 2017More than 50% of children report apian during venepuncture or intravenous cannulation and using local anaesthetics before needle procedures can lead to different success... (Comparative Study)
Comparative Study Randomized Controlled Trial
AIM
More than 50% of children report apian during venepuncture or intravenous cannulation and using local anaesthetics before needle procedures can lead to different success rates. This study examined how many needle procedures were successful at the first attempt when children received either a warm lidocaine and tetracaine patch or an eutectic mixture of lidocaine and prilocaine (EMLA) cream.
METHODS
We conducted this multicentre randomised controlled trial at three tertiary-level children's hospitals in Italy in 2015. Children aged three to 10 years were enrolled in an emergency department, paediatric day hospital and paediatric ward and randomly allocated to receive a warm lidocaine and tetracaine patch or EMLA cream. The primary outcome was the success rate at the first attempt.
RESULTS
The analysis included 172 children who received a warm lidocaine and tetracaine patch and 167 who received an EMLA cream. The needle procedure was successful at the first attempt in 158 children (92.4%) who received the warm patch and in 142 children (85.0%) who received the cream (p = 0.03). The pain scores were similar in both groups.
CONCLUSION
This study showed that the first-time needle procedure success was 7.4% higher in children receiving a warm lidocaine and tetracaine patch than EMLA cream.
Topics: Anesthetics, Local; Catheterization, Peripheral; Child; Child, Preschool; Female; Hot Temperature; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Phlebotomy; Prilocaine; Tetracaine
PubMed: 28130888
DOI: 10.1111/apa.13764 -
Journal of Pharmaceutical and... May 2022Tetracaine hydrochloride (TCH) is a nasal anesthetic and oxymetazoline hydrochloride (OZH) is a nasal decongestant. A moderate to acute overdosage of OZH and TCH can...
Rapid and sensitive simultaneous separation and electrochemical detection of tetracaine hydrochloride and oxymetazoline hydrochloride in pharmaceutical formulations via core-shell reversed-phase liquid chromatography.
Tetracaine hydrochloride (TCH) is a nasal anesthetic and oxymetazoline hydrochloride (OZH) is a nasal decongestant. A moderate to acute overdosage of OZH and TCH can lead to mydriasis, nausea, cyanosis, tachycardia, dyspnoea, cardiovascular failure, disorientation, seizures, and even death. Liquid chromatography (LC) has been mainly utilized for the individual determination of either TCH or OZH; however, there is a need for rapid and efficient methods for simultaneous analysis in pharmaceutical formulations and aqueous samples. This study highlights the use of the fast and efficient separation capabilities of core-shell silica particles in liquid chromatography (LC) for the simultaneous determination of TCH and OZH using UV detection and the enhanced selectivity afforded by electrochemical detection at a boron-doped diamond (BDD) electrode. Rapid reversed-phase (RP) separation and detection of OZH and TCH in nasal spray and eye drops was achieved within 45 s using a poroshell 120 EC-C column, by adjusting the ratio of organic solvent, mobile phase pH, detection potential and mobile phase flow rate. Sensitivity was compared using ultraviolet (UV) detection at 280 nm, and ECD at + 1.3 V with detection limits of 40 and 70 nM for TCH and OZH, respectively. The developed rapid method was utilized successfully in the analysis of pharmaceutical formulations, where the estimated levels of TCH and OZH in these formulations are in agreement with the specified values outlined by the manufacturers.
Topics: Chromatography, High Pressure Liquid; Chromatography, Reverse-Phase; Drug Compounding; Oxymetazoline; Pharmaceutical Preparations; Tetracaine
PubMed: 35358771
DOI: 10.1016/j.jpba.2022.114717 -
Fa Yi Xue Za Zhi Apr 2021Objective To study the changes of metabolites in serum and tissues (kidney, liver and heart) of mice died of acute tetracaine poisoning by metabolomics, to search...
Objective To study the changes of metabolites in serum and tissues (kidney, liver and heart) of mice died of acute tetracaine poisoning by metabolomics, to search for potential biomarkers and related metabolic pathways, and to provide new ideas for the identification of cause of death and research on toxicological mechanism of acute tetracaine poisoning. Methods Forty ICR mice were randomly divided into control group and acute tetracaine poisoning death group. The model of death from acute poisoning was established by intraperitoneal injection of tetracaine, and the metabolic profile of serum and tissues of mice was obtained by ultra-high performance liquid chromatography-electrostatic field orbitrap high resolution mass spectrometry (UPLC-Orbitrap HRMS). Multivariate statistical principal component analysis (PCA) and orthogonal partial least square-discriminant analysis (OPLS-DA) were used, combined with t-test and fold change to identify the differential metabolites associated with death from acute tetracaine poisoning. Results Compared with the control group, the metabolic profiles of serum and tissues in the mice from acute tetracaine poisoning death group were significantly different. Eleven differential metabolites were identified in serum, including xanthine, spermine, 3-hydroxybutylamine, etc.; twenty-five differential metabolites were identified in liver, including adenylate, adenosine, citric acid, etc.; twelve differential metabolites were identified in heart, including hypoxanthine, guanine, guanosine, etc; four differential metabolites were identified in kidney, including taurochenodeoxycholic acid, 11, 12-epoxyeicosatrienoic acid, dimethylethanolamine and indole. Acute tetracaine poisoning mainly affected purine metabolism, tricarboxylic acid cycle, as well as metabolism of alanine, aspartic acid and glutamic acid. Conclusion The differential metabolites in serum and tissues of mice died of acute tetracaine poisoning are expected to be candidate biomarkers for this cause of death. The results can provide research basis for the mechanism and identification of acute tetracaine poisoning.
Topics: Animals; Biomarkers; Chromatography, High Pressure Liquid; Mass Spectrometry; Metabolome; Metabolomics; Mice; Mice, Inbred ICR; Tetracaine
PubMed: 34142476
DOI: 10.12116/j.issn.1004-5619.2020.401006 -
AAPS PharmSciTech Jun 2015Eutectic mixtures formed between active pharmaceutical ingredients and/or excipients provide vast scope for pharmaceutical applications. This study aimed at the...
Eutectic mixtures formed between active pharmaceutical ingredients and/or excipients provide vast scope for pharmaceutical applications. This study aimed at the exploration of the crystallization abilities of two eutectic mixtures (EM) i.e., lidocaine-tetracaine and lidocaine-camphor (1:1 w/w). Thermogravimetric analysis (TGA) for degradation behavior whereas modulated temperature differential scanning calorimetry (MTDSC) set in first heating, cooling, and second heating cycles, was used to qualitatively analyze the complex exothermic and endothermic thermal transitions. Raman microspectroscopy characterized vibrational information specific to chemical bonds. Prepared EMs were left at room temperature for 24 h to visually examine their crystallization potentials. The degradation of lidocaine, tetracaine, camphor, lidocaine-tetracaine EM, and lidocaine-camphor EM began at 196.56, 163.82, 76.86, 146.01, and 42.72°C, respectively, which indicated that eutectic mixtures are less thermostable compared to their individual components. The MTDSC showed crystallization peaks for lidocaine, tetracaine, and camphor at 31.86, 29.36, and 174.02°C, respectively (n = 3). When studying the eutectic mixture, no crystallization peak was observed in the lidocaine-tetracaine EM, but a lidocaine-camphor EM crystallization peak was present at 18.81°C. Crystallization occurred in lidocaine-camphor EM after being kept at room temperature for 24 h, but not in lidocaine-tetracaine EM. Certain peak shifts were observed in Raman spectra which indicated possible interactions of eutectic mixture components, when a eutectic mixture was formed. We found that if the components forming a eutectic mixture have crystallization peaks close to each other and have sufficient hydrogen-bonding capability, then their eutectic mixture is least likely to crystallize out (as seen in lidocaine-tetracaine EM) or vice versa (lidocaine-camphor EM).
Topics: Anesthetics, Local; Calorimetry, Differential Scanning; Camphor; Crystallization; Hydrogen; Hydrogen Bonding; Lidocaine; Lidocaine, Prilocaine Drug Combination; Prilocaine; Temperature; Tetracaine
PubMed: 25370024
DOI: 10.1208/s12249-014-0242-4 -
Anaesthesia Apr 1969
Topics: Anesthesia, Spinal; Dibucaine; Drug and Narcotic Control; Economics; Humans; Lidocaine; Procaine; Tetracaine
PubMed: 5774706
DOI: No ID Found -
American Family Physician Jul 2002The development of topical anesthetics has provided the family physician with multiple options in anesthetizing open and intact skin. The combination of tetracaine,... (Review)
Review
The development of topical anesthetics has provided the family physician with multiple options in anesthetizing open and intact skin. The combination of tetracaine, adrenaline (epinephrine), and cocaine, better known as TAC, was the first topical agent available for analgesia of lacerations to the face and scalp. Cocaine has been replaced with lidocaine in a newer formulation called LET (lidocaine, epinephrine, and tetracaine). For analgesia to nonintact skin, LET gel is generally preferred over TAC because of its superior safety record and cost-effectiveness. EMLA (eutectic mixture of local anesthetics) is perhaps the most well-known topical anesthetic for use on intact skin. EMLA can be used to anesthetize the skin before intramuscular injections, venipuncture, and simple skin procedures such as curettage or biopsy. To be fully effective, EMLA should be applied at least 90 minutes before the procedure. ELA-Max is a new, rapidly acting topical agent for intact skin that works by way of a liposomal delivery system and is available over the counter. Other delivery vehicles for topical anesthesia currently in development, including iontophoresis and anesthetic patches, may one day give patients and physicians even more flexibility.
Topics: Administration, Topical; Ambulatory Surgical Procedures; Anesthesia, Local; Anesthetics, Local; Cocaine; Drug Combinations; Epinephrine; Humans; Iontophoresis; Lidocaine; Physicians, Family; Tetracaine; Vasoconstrictor Agents
PubMed: 12126037
DOI: No ID Found -
Academic Emergency Medicine : Official... Apr 2014
Topics: Anesthetics, Local; Corneal Injuries; Eye Injuries; Eye Pain; Female; Humans; Male; Tetracaine
PubMed: 24730412
DOI: 10.1111/acem.12359