Needle-free jet injection of lidocaine for local anesthesia during lumbar puncture: a randomized controlled trial

Area of Science:

• Pediatric Emergency Medicine
• Pain Management
• Anesthesiology

Background:

• Lumbar puncture (LP) is critical for diagnosing meningitis in emergency departments (EDs).
• Current local anesthesia methods, like subcutaneous lidocaine injections before LP, can be painful for infants.
• Needle-free jet injection technology offers an alternative for administering local anesthetics.

Purpose of the Study:

• To compare the efficacy of needle-free jet injection of 1% buffered lidocaine versus saline in reducing pain during lumbar puncture in infants.
• To evaluate the impact of needle-free lidocaine on infant distress, specifically crying time and pain scores.

Main Methods:

• A randomized, double-blinded, placebo-controlled trial was conducted on infants under 3 months old requiring LP.
• Participants received either 1% buffered lidocaine or sterile normal saline via a J-Tip needle-free jet injector prior to LP.
• Pain was assessed using the Neonatal Facial Coding System, and crying times were measured via video recording.

Main Results:

• Infants receiving lidocaine showed significantly lower mean pain scores (4.1) compared to the saline group (4.8) at needle insertion (P=0.01).
• The duration of crying was shorter in the lidocaine group (38.5 seconds) than in the saline group (48.8 seconds) (P=0.04).
• High inter-rater reliability (κ=0.76) was achieved for pain score assessments.

Conclusions:

• Needle-free jet injection of 1% buffered lidocaine effectively reduces pain and crying time in infants undergoing lumbar puncture.
• This technique provides a less painful alternative for local anesthesia prior to LP in pediatric emergency settings.
• The J-Tip device offers a promising approach to improve patient comfort during essential invasive procedures in infants.