Prevention of venipuncture pain in children: a comparative study of topical anesthetics

Abstract

Prevenção da dor na punção venosa em crianças: estudo comparativo entre anestésicos tópicos Prevención del dolor en la punción venosa en niños: estudio comparativo entre anestésicos tópicos Abstract Background: The ideal topical anesthetic to prevent venipuncture pain should have high efficacy, a quick effect, a good safety profile, be easy to apply, low cost, and well accepted. Objective: To compare the effectiveness of 5 topical anesthetics in children who require venipuncture. Methodology: A randomized controlled study was conducted involving 350 children (6 -17 years) who were randomly allocated to 5 groups. Pain was assessed using the Visual Analog Scale (0 to 10 cm). Between-group differences were analyzed using the Chi-square test and the Kruskal-Wallis test and within-group differences were analyzed using the Wilcoxon test. Results: All anesthetics were effective in preventing pain (mean pain intensity ≤1.1) and no between-group differences were found (p > 0.05). Ease of venous access, vein visibility and/or palpability, successful cannulation, and the child's cooperation were good and similar between groups (p > 0.05). Conclusion: The differences between topical anesthetics were only significant in the procedures required for their application and the costs, for which reason the use of ethyl chloride should be reconsidered. ResumoEnquadramento: O anestésico tópico ideal para prevenir a dor por punção deveria possuir alta eficácia, efeito rápido, bom perfil de segurança, fácil aplicação, baixo custo e boa aceitação. Objetivo: Comparar a efetividade de 5 anestésicos tópicos em crianças que necessitam de uma punção venosa. Metodologia: Estudo randomizado controlado envolvendo 350 crianças (6 -17 anos) com alocação randomizada em 5 grupos. A dor foi avaliada através da Escala Visual Analógica (0 a 10 cm). As diferenças entre os grupos foram analisadas pelos testes do Qui-quadrado e Kruskal-Wallis e, nos grupos, pelo teste Wilcoxon. Resultados: Todos os anestésicos revelaram eficácia na prevenção da dor (intensidade média de dor ≤ 1,1) e sem diferenças entre os grupos (p > 0,05). A facilidade de punção, visibilidade e/ou palpação da veia, o sucesso na punção e a cooperação da criança foi boa e semelhante entre os grupos (p > 0,05). Conclusão: As diferenças significativas entre os anestésicos tópicos apenas existiram nos procedimentos requeridos na sua aplicação e custos, pelo que se deve repensar o uso do cloreto de etilo.

Pain Attenuation During Peripheral Venous Catheterisation and Venipuncture Among an African Study Population: A Narrative Review.

“…The variations in the applied topical anaesthetic agent contact durations observed across the studies may be attributed to the differences in the pharmacodynamic profiles of the topical anaesthetic preparations used in the studies, coupled with a need to achieve varying depths of anaesthesia while varying the contact duration of the studied anaesthetic agents [20][21][22]. The onset of action of 5% EMLA ranges between 60 and 90 minutes [23][24]. Meanwhile, its anaesthetic effect has been reported to reach a skin depth of 3mm with a 60-minute contact time and an additional 2mm after another 60 minutes [25].…”

“…Meanwhile, its anaesthetic effect has been reported to reach a skin depth of 3mm with a 60-minute contact time and an additional 2mm after another 60 minutes [25]. The 10% lidocaine preparation has been noted to possess a faster onset of action (about 1 to 3 minutes) but a short duration of action (10 to 15 minutes) [24,26].…”

Short Peripheral Venous Catheters Contamination and the Dangers of Bloodstream Infection in Portugal: An Analytic Study

“…Overall, 30% of the analyzed PVCs were contaminated, an alarming result given that in Portugal, this vascular access device is known to be used in an array of clinical settings [ 42 , 43 , 44 ], with different patient cohorts from neonates to older adults [ 45 , 46 , 47 , 48 ], and for a myriad of therapeutic purposes such as intravenous drug and fluid therapy, chemotherapy, contrast administration, and blood sampling [ 49 , 50 , 51 , 52 , 53 ].…”