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Published on: November 9, 2016
Jet Injection of 1% buffered lidocaine versus topical ELA-Max for anesthesia before peripheral intravenous
Stephanie Spanos1, Rebekah Booth, Heidi Koenig
1Division of Pediatric Emergency Medicine and Department of Pediatrics, Kosair Children's Hospital, KY, USA. stephaniespanos@hotmail.com
Insights
J-Tip needle-free jet injection of buffered lidocaine offers superior pain relief compared to topical ELA-Max for pediatric peripheral intravenous catheter insertion. Patients reported significantly less pain with the J-Tip method.
Area of Science:
- Pediatric Emergency Medicine
- Pain Management
- Anesthesiology
Background:
- Peripheral intravenous catheter insertion is a common yet painful procedure.
- Existing pain management methods have limitations including delayed onset, inadequate anesthesia, and infection risk.
- Needle phobia is a significant concern for pediatric patients undergoing PIV insertion.
Purpose of the Study:
- To compare the anesthetic effectiveness of J-Tip needle-free jet injection of 1% buffered lidocaine versus topical 4% ELA-Max.
- To evaluate pain reduction in pediatric patients during PIV catheter insertion.
- To assess patient and observer-reported pain scores.
Main Methods:
- Prospective, randomized controlled trial involving 70 children aged 8-15 years.
- Comparison of J-Tip jet injection to 30-minute topical ELA-Max application.
- Pain assessment using Visual Analog Scale (VAS) scores, including patient self-reports and blinded reviewer assessments from video recordings.
Main Results:
- Patient-reported pain scores post-PIV insertion were significantly lower for the J-Tip group (17.3) compared to the ELA-Max group (44.6).
- Observer-reported pain scores showed a similar trend, though not statistically significant.
- Enrollment pain scores were comparable between the two groups.
Conclusions:
- J-Tip needle-free jet injection of 1% buffered lidocaine provides superior patient-assessed anesthesia compared to topical ELA-Max for PIV insertion in children.
- The J-Tip method offers a promising alternative for managing procedural pain in pediatric patients.
- Further research may explore observer-assessed outcomes and long-term efficacy.
Background:
Peripheral intravenous (PIV) catheter insertion is a frequent, painful procedure that is often performed with little or no anesthesia. Current approaches that minimize pain for PIV catheter insertion have several limitations: significant delay for onset of anesthesia, inadequate anesthesia, infectious disease exposure risk from needlestick injuries, and patients' needle phobia.
Objective:
Comparison of the anesthetic effectiveness of J-Tip needle-free jet injection of 1% buffered lidocaine to the anesthetic effectiveness of topical 4% ELA-Max for PIV catheter insertion.
Methods:
A prospective, block-randomized, controlled trial comparing J-Tip jet injection of 1% buffered lidocaine to a 30-minute application of 4% ELA-Max for topical anesthesia in children 8 to 15 years old presenting to a tertiary care pediatric emergency department for PIV catheter insertion. All subjects recorded self-reported visual analog scale (VAS) scores for pain at time of enrollment and pain felt following PIV catheter insertion. Jet injection subjects also recorded pain of jet injection. Subjects were videotaped during jet injection and PIV catheter insertion. Videotapes were reviewed by a single blinded reviewer for observer-reported VAS pain scores for jet injection and PIV catheter insertion.
Results:
Of the 70 children enrolled, 35 were randomized to the J-Tip jet injection group and 35 to the ELA-Max group. Patient-recorded enrollment VAS scores for pain were similar between groups (P = 0.74). Patient-recorded VAS scores were significantly different between groups immediately after PIV catheter insertion (17.3 for J-Tip jet injection vs 44.6 for ELA-Max, P < 0.001). Blinded reviewer assessed VAS scores for pain after PIV catheter insertion demonstrated a similar trend, but the comparison was not statistically significant (21.7 for J-Tip jet injection vs 31.9 ELA-Max, P = 0.23).
Conclusion:
J-Tip jet injection of 1% buffered lidocaine provided greater anesthesia than a 30-minute application of ELA-Max according to patient self-assessment of pain for children aged 8 to 15 years undergoing PIV catheter insertion.
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