Topical Agents

EMLA cream (lidocaine 2.5% and prilocaine 2.5%) consists of a eutectic mixture of local anesthetics. It is used to provide topical anesthetic to intact skin. Other topical preparations are effective only on mucosal surfaces. EMLA has been shown to reduce pain on venipuncture and provide substantial anesthesia for skin graft donor sites. No significant local or systemic toxicity has been demonstrated.

TAC (tetracaine, adrenalin [epinephrine], and cocaine) is a combination topical anesthetic frequently used in pediatric emergency departments for repair of minor lacerations. The usual mixture is tetracaine 0.5%, epinephrine 1:2,000, and cocaine 11.8%. Because of potential complications (seizures), lower concentrations of cocaine and epinephrine in a tetracaine 1% solution have been suggested (TAC III).

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