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Topical anesthetics for intravenous insertion in children: a randomized equivalency study
Charmaine Kleiber1, Mark Sorenson, Kathy Whiteside
1Department of Nursing, Children's Hospital of Iowa with University of Iowa Health Care, Iowa City, Iowa 52242-1083, USA. charmaine-kleiber@uiowa.edu
Insights
Eutectic mixture of lidocaine and prilocaine (EMLA) and ELA-Max provide similar pain relief for needle sticks in children. ELA-Max is effective after 30 minutes, compared to EMLA’s 60 minutes, with no difference in IV insertion success.
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.
Objectives:
Children view needle sticks as the worst source of pain and fear in the hospital setting. In an effort to minimize the pain of needle sticks, the use of eutectic mixture of lidocaine and prilocaine (EMLA) has become standard practice in many children's hospitals. Unfortunately, EMLA requires at least 60 minutes to be fully effective and reportedly may cause vasoconstriction, leading to difficult vein cannulation. A newly available local anesthetic (ELA-Max) may require less time and cause less vasoconstriction. The purpose of this randomized crossover study was to investigate the anesthetic equivalence of EMLA and ELA-Max.
Methods:
Thirty well children (14 girls and 16 boys) who were between the ages of 7 and 13 years volunteered to have EMLA applied to the dorsal aspect of 1 hand for 60 minutes and ELA-Max applied to the other hand for 30 minutes. Right and left hands were randomized to treatment type and order of intravenous (IV) insertion. Clinical Research Center nurses, blind to the anesthetic randomization, attempted to insert a 22-gauge Teflon IV catheter into a vein in each hand. The children rated pain during IV insertion on the Oucher scale, and the nurse rated the difficulty of the insertion.
Results:
There was no significant difference in pain ratings for hands that were treated with EMLA (mean: 20.5) or with ELA-Max (mean: 24), and there was no difference for the difficulty of vein cannulation. Children's preprocedure state anxiety was positively associated with pain ratings.
Conclusions:
ELA-Max, applied for 30 minutes before IV cannulation, has an anesthetic effectiveness similar to EMLA applied for 60 minutes. Some children rated IV insertion pain fairly high for both hands (eg, 60 on a 0- to 100-point scale) despite anesthetic treatment. Preprocedural anxiety may affect the perception and/or rating of pain. There were no differences between hands that were treated with EMLA or with ELA-Max for success of IV insertion.