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A study of lidocaine iontophoresis for pediatric venipuncture
John B Rose1, Jeffrey L Galinkin, Ellen C Jantzen
1Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, School of Medicine, Philadelphia 19104, USA. rose@email.chop.edu
Insights
Lidocaine iontophoresis effectively reduces venipuncture pain in children. This safe and well-tolerated treatment significantly improves patient and observer satisfaction compared to placebo.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Dermatology
Background:
- Venipuncture is a common procedure in children, often associated with significant pain and anxiety.
- Effective pain prevention strategies are crucial for improving pediatric patient experience and compliance.
Purpose of the Study:
- To evaluate the safety and efficacy of lidocaine iontophoresis for preventing venipuncture pain in pediatric patients.
- To compare patient, parent, and nurse satisfaction with lidocaine iontophoresis versus placebo.
Main Methods:
- A randomized, double-blinded, placebo-controlled study involving 59 children aged 6-17 years.
- Participants received either lidocaine HCl 2% with epinephrine or a placebo via iontophoresis.
- Pain and satisfaction were assessed using a 100-mm visual analog scale.
Main Results:
- Lidocaine iontophoresis group reported significantly lower pain scores (subject, nurse, and parent assessments) compared to placebo (P < 0.002).
- Higher satisfaction scores were observed in the active treatment group across all evaluators.
- Adverse events were mild and infrequent, with 10 subjects experiencing 12 mild events.
Conclusions:
- Lidocaine iontophoresis is a safe and effective method for dermal anesthesia prior to venipuncture in children.
- The treatment significantly reduces procedural pain and enhances overall satisfaction.
- This approach offers a valuable option for pediatric pain management during blood draws.
Unlabelled:
In this randomized, double-blinded, placebo-controlled study, we evaluated the safety and efficacy of lidocaine iontophoresis for the prevention of pain associated with venipuncture in 59 children aged 6-17 yr. Children received either lidocaine HCl 2% with epinephrine 1:100,000 (Active) or the same formulation without lidocaine (Placebo) via a 20 mA/min iontophoretic treatment. Pain during venipuncture was assessed by the subject, parent, and nurse using a 100-mm visual analog scale. Median (interquartile range) visual analog scale scores were significantly lower in the Active versus Placebo groups: subject, 7.0 (2.0-20.8) versus 31.0 (12.0-48.0), P < 0.001; nurse, 5.0 (2.2-10.8) versus 24.0 (9.0-47.0), P < 0.001; and parent, 3.0 (0.8-7.2) versus 20.0 (4.5-43.0), P < 0.002, respectively. Similarly, higher median satisfaction scores were given to the Active versus Placebo group by the three evaluators. Of the 59 subjects completing the study, 10 subjects experienced a total of 12 adverse events that were all graded as mild. In conclusion, lidocaine iontophoresis is safe in children, reduces discomfort associated with venipuncture, and increases satisfaction when compared with the placebo.
Implications:
In this randomized, double-blinded, placebo-controlled study, we found that dermal anesthesia with lidocaine HCl 2% combined with epinephrine 1:100,000 administered via iontophoresis in children is achieved in 8.8 +/- 2.1 min, reduces discomfort associated with venipuncture, is safe, and increases satisfaction when compared with the placebo.