Effect of topical alkane vapocoolant spray on pain with intravenous cannulation in patients in emergency departments: randomised double blind placebo controlled trial

Abstract

Objective To assess the efficacy, acceptability, and safety of a topical alkane vapocoolant in reducing pain during intravenous cannulation in adults.Design Randomised double blind placebo controlled trial.Setting Emergency department of a metropolitan teaching hospital.Participants 201 adult patients (54% male), mean (SD) age 58.2 (19.5) years, who required intravenous cannulation.Interventions Less than 15 seconds before cannulation, the skin area was sprayed with either water (control, n=98) or vapocoolant (intervention, n=103), from a distance of 12 cm for 2 seconds. The intervention spray was a blend of propane, butane, and pentane.Main outcome measures Pain with cannulation and discomfort with spray, measured with a 100 mm visual analogue scale.Results Groups did not differ significantly in age, sex, indication for or site of cannulation, cannula size, or who cannulated the patient (P>0.05). Median (interquartile range) pain scores for cannulation in the control and intervention groups were 36 (19-51) and 12 (5-40) mm, respectively (P<0.001), and 59 (60%) and 33 (32%) reported pain scores ≥30 mm (P<0.001). Scores for spray discomfort also differed significantly (P<0.001) because of skewing to the right within the intervention group. The median discomfort scores, however, were 0 mm in both groups. Success rates for first cannulation attempt did not differ between groups (P=0.39). Thirty four (39%) and 62 (62%) patients said they would choose the spray they received for analgesia in the future (P=0.002). At follow-up at five days, two patients in the intervention group reported transient skin redness.Conclusions Topical alkane vapocoolant spray is effective, acceptable, and safe in reducing pain with peripheral intravenous cannulation in adults in the emergency department.Trial registration Australian Clinical Trials ACTRN12607000470493.

Effects of vapocoolant spray on skin sterility prior to intravenous cannulation

“…Studies of cannulation following alkane vapocoolant administration also found no significant differences in unexpected events in the vapocoolant groups compared with both lignocaine and placebo administration. 5,7 This study found that alkane vapocoolant spray, when used for local anaesthesia prior to IV cannulation, does not contaminate the sterile cannulation site. It does not appear that bacteria are transmitted from either the spray nozzle or washed from the operator's hand.…”

“…2e5 Accordingly, less than 20% of medical and surgical doctors use a local anaesthetic agent for the insertion of commonly used cannulae (20 gauge), and less than one-half use a local anaesthetic agent for the insertion of large-bore cannulae. 6 Hijazi et al 5 reported that the administration of a topical alkane spray (vapocoolant), immediately prior to cannulation, reduces the pain of cannulation significantly. Page and Taylor 7 compared vapocoolant spray with subcutaneous lignocaine.…”

Application of a topical vapocoolant spray decreases pain at the site of initial intradermal anaesthetic injection during ultrasound-guided breast needle biopsy

“…8 Less pain has also been reported with vapocoolant spray use immediately prior to intravenous cannulation and immunisations. 9,10 The purpose of the present study was to assess whether the application of a topical vapocoolant spray immediately prior to the initial intradermal anaesthetic injection at the start of ultrasound-guided breast biopsy decreases pain at the site of the initial injection.…”

Effects of Ethyl Chloride Spray on Pain and Parameters of Needle Electromyography in the Upper Extremity

“…1Y3 Ethyl chloride spray has been used for decades to safely reduce the symptoms of myofascial pain syndromes, 4 and it has also been used in several minor invasive procedures such as intravenous cannulation and vaccination. 5,6 It has been recently found that ethyl chloride spray is more effective than topical anesthetic cream for reducing pain during needle electromyography of the gastrocnemius. 7 However, any effects of cooling on the parameters of the motor unit action potential (MUAP) were not investigated, which might be affected by focal cooling induced by evaporation.…”