Topical anesthetics for intravenous insertion in children: a randomized equivalency study

Area of Science:

• Pediatric Anesthesiology
• Pain Management
• Dermatology

Background:

• Needle-stick pain is a significant source of distress for children in healthcare settings.
• Eutectic mixture of lidocaine and prilocaine (EMLA) is a common anesthetic but requires a lengthy application time (60 minutes) and may cause vasoconstriction.
• A newer anesthetic, ELA-Max, offers potential advantages in reduced application time and less vasoconstriction.

Purpose of the Study:

• To compare the anesthetic effectiveness and vein cannulation success of ELA-Max versus EMLA in pediatric patients.
• To determine if ELA-Max, applied for a shorter duration, is equivalent to EMLA applied for a longer duration.

Main Methods:

• A randomized crossover study involving 30 children aged 7-13 years.
• EMLA was applied to one hand for 60 minutes, and ELA-Max was applied to the other hand for 30 minutes.
• Pain during intravenous (IV) insertion was rated by children, and insertion difficulty was rated by nurses.

Main Results:

• No significant difference in pain ratings between EMLA and ELA-Max.
• No significant difference in the difficulty of vein cannulation between the two anesthetics.
• Children's pre-procedure anxiety was positively correlated with pain ratings.

Conclusions:

• ELA-Max applied for 30 minutes demonstrates comparable anesthetic effectiveness to EMLA applied for 60 minutes.
• Both anesthetics showed no difference in IV insertion success rates.
• Preprocedural anxiety may influence children's perception and reporting of pain during needle procedures.