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Pain reduction in children during port-à-cath catheter puncture using local anaesthesia with EMLA™

Birke Lüllmann1, Johannes Leonhardt, Martin Metzelder

  • 1Department of Paediatric Haematology and Oncology, Medical University, Hannover, Germany.

European Journal of Pediatrics
|July 13, 2010
PubMed

Insights

For children undergoing chemotherapy, applying eutectic mixture of lidocain-prilocain cream (EMLA) for 60 minutes significantly reduces port-à-cath puncture pain compared to 40 minutes. Child-reported pain scores showed greater improvement with longer EMLA application.

Area of Science:

  • Pediatric Oncology
  • Pain Management
  • Dermatology

Background:

  • Alleviating pain in children undergoing chemotherapy is crucial.
  • Eutectic mixture of lidocaine-prilocaine cream (EMLA) is commonly used for procedural pain.
  • Current practice often assumes a 60-minute application time for EMLA effectiveness.

Purpose of the Study:

  • To prospectively compare the efficacy of 40-minute versus 60-minute EMLA application for reducing pain during port-à-cath punctures in pediatric cancer patients.
  • To evaluate the difference in pain perception between children, parents, and nurses based on EMLA application duration.

Main Methods:

  • A prospective, unblinded, cross-over study involving 87 children (2-18 years) with malignant diseases.
  • Each child received two port-à-cath punctures, one after 40 minutes and another after 60 minutes of EMLA application.
  • Pain was assessed using the Visual Analogue Scale (VAS) and Bieri scale by the child, parents, and a nurse.

Main Results:

  • Observer-rated pain (nurse and parent) showed minimal difference between 40 and 60 minutes of EMLA application (VAS: 2.3 vs 1.9).
  • Children reported significantly higher pain after 40 minutes (VAS: 3.5) compared to 60 minutes (VAS: 1.7).
  • A notable reduction in pain was observed even after 40 minutes of EMLA application.

Conclusions:

  • Sixty minutes of EMLA application provides superior pain relief for port-à-cath punctures in children undergoing chemotherapy compared to 40 minutes.
  • Children's self-reported pain scores are a critical component of pain assessment and may differ from observer ratings.
  • EMLA application for at least 40 minutes demonstrates pain reduction, with further benefits observed at 60 minutes.
Abstract

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