A Randomized Clinical Trial of Dermal Anesthesia by Iontophoresis for Peripheral Intravenous Catheter Placement in Children

Kim, Michael K.; Kini, Narendra; Troshynski, Todd J.; Hennes, Halim

doi:10.1016/s0196-0644(99)70302-1

Cited by 60 publications

(32 citation statements)

References 8 publications

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“…[75][76][77] These studies demonstrated that a 10-to 15-minute treatment with Numby Stuff provided significantly more pain relief than iontophoresis of placebo (saline). The efficacy of the device has also been compared with lidocaine and prilocaine cream 26,[78][79][80] and lidocaine infiltration.…”

Section: Lidocaine Iontophoresismentioning

confidence: 96%

“…Intolerable tingling, itching, burning sensation, and discomfort have been documented in trials, 78,79 and 23% of the children in 1 study required a temporary reduction in the initial current. 75 Some evidence indicates that these adverse effects, which are related to iontophoretic current, can be mitigated by using a lower iontophoretic dose. 81 Burns, which have been reported to occur at incidences of 1 per 15 000 to 20 000 treatments, 82 can be caused by faulty electrode design, placement of electrodes over skin defects or other areas of low resistance, excessive current levels or iontophoretic dose, or the build-up of HCl or NaOH under the anode and cathode, respectively.…”

Section: Lidocaine Iontophoresismentioning

confidence: 99%

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Pharmacologic Approaches for Reducing Venous Access Pain in Children

Zempsky

2008

Pediatrics

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A variety of pharmacologic options are available to clinicians who want to provide effective and safe topical local anesthesia to children undergoing venous access procedures. These options can be distinguished on the basis of how they deliver active drug through the impermeable outer layer of skin, the stratum corneum, to pain receptors located in the dermis and epidermis. Three general methodologies are typically used to bypass the stratum corneum: direct injection of local anesthetics, usually via a small-gauge hypodermic syringe; passive diffusion from topical creams or gels; and active needle-free drug strategies that enhance the rate of drug passage into the dermis and epidermis. Examples of the latter mechanisms include heatenhanced diffusion, iontophoresis, sonophoresis, laser-assisted transdermal passage, and pressurized gas delivery of powdered drug particles. Pharmacologic options in this setting can also be distinguished on the basis of the time to onset of full anesthetic effect. Several available agents induce significant local anesthesia within 1 to 3 minutes of administration, or faster, allowing easy integration into the skin preparation and subsequent venous access procedure. In combination with nonpharmacologic approaches, these agents can be used to dramatically lessen this significant source of pediatric pain. Pediatrics 2008;122:S140-S153

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Section: Lidocaine Iontophoresismentioning

confidence: 96%

Section: Lidocaine Iontophoresismentioning

confidence: 99%

Pharmacologic Approaches for Reducing Venous Access Pain in Children

Zempsky

2008

Pediatrics

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“…108,109 Iontophoresis of lidocaine is effective and has an onset of effect of 10 minutes but requires an initial investment in the equipment. 110,111 Vapocoolant sprays, ethyl chloride and fluoromethane, produce immediate brief (seconds) anesthesia but may not be tolerated well by young children. 112 Although effective, rapid-onset topical anesthetics exist, they are underused for minor procedures.…”

Section: Pharmacologic Interventionsmentioning

confidence: 99%

Pediatric procedural pain

Young¹

2005

Annals of Emergency Medicine

269

233

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“…Reports suggest that iontophoresis provides effective pain relief for venous catheter placement or THERAPEUTIC MODALITIES 611 Current Concepts venipuncture within 10 to 20 minutes. 201,[203][204][205][206] The drug is administered in a volume of 0.6 to 1.0 mL of 2% lidocaine with epinephrine, and should not be used in patients with sensitivity to amide anesthetics, with pacemakers, or with lesions near the eye, and over metal indwelling catheters. 206 The demand on provider time relative to other techniques, major local skin reactions (including burns), and the emergence of topical lidocaine creams that have an onset of action similar to iontophoresis have limited the use of this technique in clinical practice.…”

Section: Evidencementioning

confidence: 99%