Correlates of Pain-Related Responses to Venipunctures in School-Age Children

Bournaki, Marie-Christine

doi:10.1097/00005721-199709000-00015

Cited by 2 publications

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“…[1][2][3][4] Topical anesthetics such as EMLA (AstraZeneca, Wilmington, DE; a eutectic mixture of 2.5% lidocaine and 2.5% prilocaine) and L.M.X.4 (Ferndale Laboratories, Ferndale, MI; 4% lidocaine) have been shown to provide effective local anesthesia for venipuncture and intravenous cannulation. [5][6][7][8][9] However, a period of 30 to 90 minutes, depending on the product and the procedure, may be required between application and the onset of effect, limiting the usefulness of these products in busy health care settings and for emergency department applications.…”

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confidence: 99%

Rapid, Needle-Free Delivery of Lidocaine for Reducing the Pain of Venipuncture Among Pediatric Subjects

Migdał

Chudzynska-Pomianowska

Vause³

et al. 2005

Pediatrics

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ABSTRACT. Objectives. The purpose of this study was to determine the optimal configuration of an investigational, single-use, needle-free, drug system (ALGRX 3268) that delivers powdered lidocaine into the epidermis for the rapid production of local anesthesia among pediatric subjects undergoing venipuncture.Methods. Children 3 to 18 years of age were randomly allocated to receive 1 of 3 treatments, ie, (1) placebo, (2) a system configured to deliver 0.25 mg of lidocaine, or (3) a system configured to deliver 0.5 mg of lidocaine, at the antecubital fossa 2 to 3 minutes before venipuncture. Three age groups were included, ie, 3 to 7 years, 8 to 12 years, and 13 to 18 years. Two sets of pain rating scales were used, the Faces Pain Scale-Revised for the youngest age stratum and a visual analog scale for the oldest age stratum. Children in the middle age stratum used both scales.Results. One-hundred forty-four subjects completed the study. For all ages combined, there was a statistically significant and clinically meaningful reduction in pain scores for subjects who received 0.5 mg of lidocaine, compared with placebo. The reduction in pain after 0.25 mg of lidocaine did not achieve statistical significance.Conclusions. Both active configurations were safe and well tolerated by pediatric subjects undergoing venipuncture at the antecubital fossa. ALGRX 3268 at 0.5 mg, administered 2 to 3 minutes before venipuncture, produced significantly lower pain scores, compared with placebo. [5][6][7][8][9] However, a period of 30 to 90 minutes, depending on the product and the procedure, may be required between application and the onset of effect, limiting the usefulness of these products in busy health care settings and for emergency department applications. [9][10][11] The delivery of lidocaine to the skin through iontophoresis has also been investigated among children undergoing venipuncture or intravenous catheter insertion. 12,13 Iontophoretic lidocaine systems feature a controller and disposable, drug-saturated electrodes and use the application of an electric current to carry ionized lidocaine through the skin. 13 Lidocaine iontophoresis has been shown to be more effective than placebo in reducing the pain of venipuncture and to be comparable to EMLA for intravenous catheter placement. 12,13 However, studies indicate that lidocaine iontophoresis requires up to 15 minutes for onset of effect. 14 This study was undertaken to evaluate an investigational, needle-free, single-use, prefilled, disposable system (ALGRX 3268; AlgoRx Pharmaceuticals Inc, Secaucus, NJ) capable of delivering fine, dry, powdered lidocaine into the epidermis for the rapid production (within 1-3 minutes) of local anesthesia before venipuncture. The system is placed against the skin at the site of venipuncture and is triggered simply by pressing of the actuator button (Fig 1). Pressurized, medical-grade, helium gas within the system accelerates lidocaine particles to velocities sufficient to penetrate the outer skin layers and produce local anesthesia. ...

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confidence: 99%

Rapid, Needle-Free Delivery of Lidocaine for Reducing the Pain of Venipuncture Among Pediatric Subjects

Migdał

Chudzynska-Pomianowska

Vause³

et al. 2005

Pediatrics

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“…Studies measuring heart rate changes secondary to painful stimuli (heel lancing, venipuncture, and intravenous [IV] catheter placement) in pediatric patients have yielded conflicting results. [6][7][8] An unpublished trial performed in an ED showed no correlation between heart rate or blood pressure and adult patients' perceived pain intensity. 9 Previous studies have shown that nurses may use vital signs as a proxy for need for analgesics.…”

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confidence: 99%

Heart Rate Response to Intravenous Catheter Placement

Bartfield

2003

Academic Emergency Medicine

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Objective: To investigate the relationship between change in heart rate and pain and anxiety caused by intravenous catheter (IV) placement. Methods: An observational study was performed in a university-based tertiary care emergency department. Patients who required IV placement as part of their management were considered as possible subjects. Heart rates were recorded at the following times: baseline, tourniquet placement, and IV placement. Immediately after IV placement, subjects recorded pain and anxiety scores using 100-mm visual analog scales. Percentage change in heart rate (compared with baseline) was calculated at time of tourniquet placement (anxiety) and IV placement (pain). Simple linear regression analyses were performed comparing pain scores with percent change in heart rate at the time of IV and tourniquet placement.Significance was defined as p \ 0.05. Results: Ninety subjects were enrolled. Subjects had a mean age of 48 years, and 54% were women. There was a normal distribution of heart rate changes, with greater than 80% of all subjects having a 10% or less change in heart rates. The results of the analysis of pain scores versus percentage change in heart rate at IV placement yielded a Pearson correlation coefficient of 0.13 (p ¼ 0.2). The results of the analysis of anxiety scores versus percentage change in heart rate at tourniquet placement yielded a Pearson correlation coefficient of 0.014 (p ¼ 0.9). Conclusions: Changes in heart rate do not correlate with pain and anxiety associated with IV placement. Key words: pain measurement; heart rate. ACADEMIC EMERGENCY MEDICINE 2003; 10:1005-1008 Pain and pain management are frequently encountered problems in the emergency department (ED). Some textbooks state that painful stimuli can cause an autonomic nervous system response that increases a patient's heart rate, 1-3 and some clinicians may use this concept in their assessment of a patient's pain. Other textbooks state that there is an unpredictable heart rate response to pain. 4,5 Little research has been done to show a cause-and-effect relationship between pain and heart rate in humans. Studies measuring heart rate changes secondary to painful stimuli (heel lancing, venipuncture, and intravenous [IV] catheter placement) in pediatric patients have yielded conflicting results.6-8 An unpublished trial performed in an ED showed no correlation between heart rate or blood pressure and adult patients' perceived pain intensity. 9Previous studies have shown that nurses may use vital signs as a proxy for need for analgesics. 10,11 Patients who present to the ED with painful conditions frequently are undertreated with analgesics.12,13 One possible reason might be a lack of tachycardia in patients who complain of pain. We sought to investigate the relationship of heart rate to pain. The purpose of this study was to analyze the effect of pain caused by IV catheter insertion on heart rate in adult ED patients. The null hypothesis was that heart rate would not increase in a predictable manner in response...

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Correlates of Pain-Related Responses to Venipunctures in School-Age Children

Cited by 2 publications

References 0 publications

Rapid, Needle-Free Delivery of Lidocaine for Reducing the Pain of Venipuncture Among Pediatric Subjects

Rapid, Needle-Free Delivery of Lidocaine for Reducing the Pain of Venipuncture Among Pediatric Subjects

Heart Rate Response to Intravenous Catheter Placement

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