Alleviation of the pain of venepuncture in neonates

A recent study has shown venepuncture to be more effective and less painful than heel-lancing when a single blood test is performed in neonates [Larsson, Pediatrics (in press)]. The aim of the present study was to investigate the value of EMLA applied on the dorsum of the hand when sampling blood in neonates.

This was a controlled randomized and double-blinded study. One hundred and twenty neonates were randomly allocated to two groups, EMLA or placebo. Five hundred milligrams (0.5 ml) of EMLA or placebo was placed on the dorsum of the hand, covered with an occlusive dressing, and left in place for 60 minutes. For venepuncture, a needle measuring 0.9 x 40 mm was used. The two groups were also compared as regards the total time needed to complete the PKU test and the number of skin punctures required. The facial reaction was videotaped and later analysed by two blinded observers using the Neonatal Facial Coding System (NFCS).

No side effects occurred, except for a temporary blanching or redness of the skin, which disappeared within minutes. Nociceptive response: After skin puncture, the NFCS scores were significantly lower in the EMLA group than in the placebo group (median 287 and 374, respectively). After the first skin puncture, a cry was recorded in 35/55 cases (64%) in the EMLA group and in 38/56 cases (68%) in the placebo group, this difference was not significant. The duration of the first cry was significantly shorter in the EMLA than in the placebo group (median 12 and 31 s, respectively).

In comparison with a placebo, EMLA significantly reduces the pain caused by venepuncture on the dorsum of the hand and does not complicate puncture of the vein.