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Comparison of EMLA cream versus placebo in children receiving distraction therapy for venepuncture
M K Lal1, J McClelland, J Phillips
1Department of Paediatrics, Peterborough District Hospital, UK.
Insights
Distraction therapy effectively reduces pain during venepuncture in children. This study found no significant difference in pain scores between children receiving Eutectic mixture of local anaesthetics (EMLA) cream and those receiving a placebo when distraction was used.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Child Psychology
Background:
- Eutectic mixture of local anaesthetics (EMLA) cream is commonly used for venepuncture pain in children.
- A significant number of children still experience distress despite EMLA use.
- Distraction therapy is a cognitive-behavioral intervention with limited data on its effectiveness.
Purpose of the Study:
- To evaluate the efficacy of distraction therapy as a coping strategy before and during venepuncture in children.
- To assess the necessity of EMLA cream when distraction therapy is employed.
Main Methods:
- Prospective, randomized, double-blind, placebo-controlled clinical trial.
- 28 children (median age 6 years) were randomized to EMLA or placebo cream.
- All participants received distraction therapy from a play specialist during venepuncture.
Main Results:
- No significant difference in pain scores between the EMLA and placebo groups (p = 0.7).
- Low median pain scores in both groups suggest distraction therapy's effectiveness.
- The 95% confidence interval for the difference in pain score was -1.0 to +3.0.
Conclusions:
- Distraction therapy appears effective in managing venepuncture pain in children.
- EMLA cream may not be necessary for this age group when distraction therapy is carefully implemented.
- Operator skill and patient experience are relevant factors in pain management.
Unlabelled:
Eutectic mixture of local anaesthetics (EMLA) cream is used routinely as a local anaesthetic prior to venepuncture in children. Despite this, however, a significant proportion of children will still be distressed. Cognitive-behavioural interventions, such as distraction by breathing and blowing exercises, have been used and found to be helpful as alternative coping strategies. There is, however, a paucity of data regarding effectiveness. We have evaluated the efficacy of distraction therapy as a coping strategy before and during venepuncture, and in these children evaluated the need for EMLA using a prospective, randomized, double-blind, placebo-controlled clinical trial. Twenty-eight children attending for venepuncture were recruited, median age 6 y (range 4-8 y), and randomly allocated to receive either EMLA or a placebo cream. All were given distraction therapy prior to and during the procedure by a play specialist. Venepuncture was carried out by one investigator. A modified paediatric pain assessment chart was used for objective pain score at the end of the procedure. After one exclusion, the treatment group (17 children) and the placebo group (10 children) were similar: median age of 6 and 7 y (range 4-8), median baseline and post-procedure heart rate and oxygen saturation. The median (interquartile range) for total pain score in the treatment group was 1 (0 to 4.5) and in the control group 1 (0 to 2.3). There was no significant difference in pain score between the two groups (Mann-Whitney test, p = 0.7). The 95% confidence interval for the difference in pain score was -1.0 to +3.0.
Conclusions:
The low pain score in both groups suggests the effectiveness of distraction therapy, although factors such as skill of the operator and previous experience of the patient group are of relevance. There was no significant difference in the pain score between the EMLA and placebo groups, suggesting that in this age group if carefully selected children receive distraction during venepuncture EMLA may not be necessary.