Comparing ethyl chloride and 10% lignocaine spray for pediatric intravenous cannulation pain relief

Intravenous cannulation (IVC) is a routine yet distressing procedure in pediatric patients, often provoking significant anxiety and procedural pain. Although eutectic mixtures such as eutectic mixture of local anesthetic cream are widely used, their delayed onset limits their applicability in time-sensitive settings. Ethyl chloride vapocoolant spray and 10% lignocaine spray have been proposed as rapid-onset alternatives, yet direct comparative evidence in children is scarce.

This study aimed to compare the analgesic efficacy, onset of action, and ease of IVC between ethyl chloride vapocoolant spray and 10% lignocaine spray in pediatric patients undergoing elective surgery.

A prospective, randomized, double-blinded trial was conducted in a tertiary care hospital between 2022 and 2024 following ethics approval (IEC:279/2022) and trial registration (CTRI/2023/08/056580). Sixty children aged 8-17 years (American Society of Anesthesiologists [ASA] I-II) scheduled for elective procedures were randomized to receive either 3 sprays of 10% lignocaine (group L) or ethyl chloride spray (group E) before IVC. Pain was assessed using the visual analogue scale (ASA=0-100 mm), ease of cannulation with a 4-point Likert scale, and procedural time was recorded. Failed cannulations, adverse events, and rescue analgesia requirements were noted. Data were analyzed using IBM SPSS Statistics ver. 22.0 with a significance threshold of P<0.05.

Group E demonstrated significantly lower VAS scores (30.43±0.9 mm) compared to group L (70.03±1.07 mm, P<0.001). Mean cannulation time was shorter in group E (16.07±2.41 seconds) than group L (24.57±4.42 seconds, P<0.001). Ease of cannulation was superior in group E, with 100% of patients reporting no difficulty, whereas only 67.8% in group L reported the same (P= 0.002). No adverse effects or serious complications were observed in either group.

Ethyl chloride vapocoolant spray provides significantly superior dermal analgesia, faster onset, and improved ease of IVC compared to 10% lignocaine spray in children aged 8-17 years. Its rapid action and safety profile make it a valuable alternative in pediatric anesthesia practice, particularly in time-sensitive clinical settings.