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EMLA versus nitrous oxide for venous cannulation in children
O Paut1, C Calméjane, J Delorme
1Department of Pediatric Anesthesia and Intensive Care, La Timone University Hospital, Marseilles, France. opaut@ap-hm.fr
Insights
Both EMLA cream and nitrous oxide (N2O) effectively relieve pain during pediatric venous cannulation. Minor side effects were more frequent with N2O, but both methods demonstrated adequate pain management.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Medical Device Technology
Background:
- Venous cannulation in children can cause significant pain and distress.
- Effective pain management strategies are crucial for pediatric procedures.
- Comparing topical anesthetics with inhaled agents offers insights into procedural comfort.
Purpose of the Study:
- To compare the efficacy of EMLA cream versus nitrous oxide (N2O) for pain relief during venous cannulation in children.
- To evaluate patient-reported pain scores and procedural ease.
- To assess the incidence of side effects associated with each intervention.
Main Methods:
- A prospective, double-blinded, randomized study involving 40 children aged 6-11 years.
- Participants received either EMLA cream or a placebo cream, combined with inhaled air/oxygen or 70% N2O/oxygen, respectively.
- Pain was assessed using Visual Analog Scale (VAS) and Objective Pain Scale (OPS); procedural ease and physiological variables were also monitored.
Main Results:
- No statistically significant differences were found in VAS scores, OPS scores, or ease of cannulation between the EMLA and N2O groups.
- Both EMLA and N2O provided adequate pain relief, indicated by low pain scores.
- Minor side effects were significantly more common in the N2O group (11/20) compared to the EMLA group (7/20).
Conclusions:
- EMLA cream and nitrous oxide are equally effective in providing pain relief during venous cannulation in children.
- EMLA cream may be associated with fewer minor side effects compared to nitrous oxide.
- Both interventions offer adequate pain management for this common pediatric procedure.
Abstract:
We compared EMLA cream with nitrous oxide (N(2)O) for providing pain relief during venous cannulation in children. In a prospective, double-blinded, randomized study, 40 children, 6-11 yr, ASA status I or II, undergoing scheduled surgery received either EMLA cream and inhaled air and oxygen (Group EMLA) or a placebo cream and inhaled 70% N(2)O in oxygen (Group N(2)O) before venous cannulation. Pain was evaluated with a visual analog scale and the Objective Pain Scale. The ease of venous cannulation and the observer's assessment of its efficacy for preventing pain were assessed. Heart rate, blood pressure, respiratory rate, and oxygen saturation were compared before and after venous cannulation. Visual analog scale scores (4.4 +/- 7.5 vs 3.9 +/- 9.3 mm, P = 0.85), Objective Pain Scale scores (median 0 [0-6] vs 0 [0-1], P = 0.61), efficacy (median 0 [0-1] vs 0 [0-1], P = 0.59), and ease of venous cannulation (0 [0-2] vs 0 [0-1], P = 0.84) were not different between EMLA and N(2)O groups, respectively. There was no statistical difference between the groups for the physiologic variables. Minor side effects were significantly more common in the N(2)O group (11 of 20) than in the EMLA group (7 of 20) (P = 0.0248). We conclude that both techniques provided adequate pain relief during venous cannulation, as demonstrated by the low pain scores.