Mitigating procedural pain during venipuncture in a pediatric population: A randomized factorial study

Evidence suggests that a significant number of children receive less than optimal management of procedure-related pain.

To determine if there was a difference in the perceived pain associated with a venipuncture procedure in a group of pediatric patients based on the preparatory intervention used during the procedure and, to determine if age, sex, or ethnic group were associated with the effectiveness of the preparatory interventions used.

A quasi-experimental, 3×4 factorial design was used.

Participants were recruited from a non-profit, regional hospital in the southeast United States.

Participants were recruited from children between the ages of 18 months and 17 years who were admitted to the facility. Criteria for inclusion was the first needle stick during admission with a parent or guardian present, English as the primary language. Potential participants were excluded if they had previous experience with any of the preparatory interventions, were sedated, unconscious, hemodynamically unstable, developmentally delayed for their age, or had a known chronic condition. Of the 285 participants consented to participate, 173 children completed the process including 35 (20.2%) toddlers, 34(19.7%) preschool and 65 (37.6%) school age children, and 39 (22.5%) adolescents. There were 77 (44.5%) females and 96 (55.5%) males; and 101 (58.4%) non-Hispanic white children and 72 (41.6%) minority children.

Children were randomized to one of three treatment interventions. There was a purposeful effort to include representative numbers of each age group, ethnic group, and sex and in each treatment group. Measures of pain before and after the procedure included an observational measure completed by the parent/guardian and a self-report measure completed by the two older age groups.

There were no statistically significant differences among treatment groups based on the observational measures of pain or the self-report measures of pain. There was a statistically significant interaction between ethnic group and treatment group (p=0.006) based on the observational measure of pain which was also found between ethnic group and treatment group (p=.04) based on self-report scores in school age children and adolescents.

Findings support the use of both mechanical vibration and topical anesthetic as effective in children regardless of age group or sex. Further, the interaction between ethnic group and treatment contributes to a growing body of knowledge that suggests ethnic group is an important factor in the pain response and requires further study in an effort to better customize approaches to pain management in children.