What are the adverse effects of local anesthetic mixtures containing cocaine?

Updated: Jan 09, 2019
  • Author: Raffi Kapitanyan, MD; Chief Editor: David Vearrier, MD, MPH  more...
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Various anesthetic mixtures containing cocaine have been used to provide topical anesthesia for suturing of minor skin lacerations, especially on the face or scalp. One such combination that is extemporaneously prepared by hospital pharmacies includes tetracaine 0.5%, epinephrine (adrenaline) 1:2000, and cocaine 11.8% (commonly referred to as "TAC" solution). TAC is particularly useful in patients who are unable to tolerate injections or who have difficulty following instructions or sitting still (eg, children, mentally challenged individuals).

However, serious toxic effects (eg, seizures, cardiac death) have been described after topical cocaine application, particularly in infants and children. Because of this toxicity, as well as expense and federal regulatory issues, cocaine is no longer recommended for topical anesthesia.

Newer compounded mixtures have replaced cocaine with lidocaine 4% solutions (lidocaine, epinephrine, tetracaine) because of its superior safety when applied to injured skin. Still, these solutions should not be applied to wounds with end-arteriolar blood supply.

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