The effect of vapocoolant spray on pain due to intravenous cannulation in children: a randomized controlled trial

Farion, Ken; Splinter, Karen L.; Newhook, Kym; Gaboury, Isabelle; Splinter, William M.

doi:10.1503/cmaj.070874

Cited by 93 publications

(84 citation statements)

References 30 publications

(25 reference statements)

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“…Vapocoolant sprays have variably been reported to be ineffective (Costello et al, 2006 Level II) or reduce pain (Farion et al, 2008 Level II) associated with IV cannulation, and to be as effective as topical amethocaine in children undergoing venipuncture (Davies & Molloy, 2006 Level III-1).…”

Section: Venipuncture and Intravenous Cannulationmentioning

confidence: 99%

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

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Objectives: This study aimed to assess analgesia provided by acupuncture, alone or in combination with pharmacotherapy, to patients presenting to emergency departments with acute low back pain, migraine or ankle sprain. Design: A pragmatic, multicentre, randomised, assessor‐blinded, equivalence and non‐inferiority trial of analgesia, comparing acupuncture alone, acupuncture plus pharmacotherapy, and pharmacotherapy alone for alleviating pain in the emergency department. Setting, participants: Patients presenting to emergency departments in one of four tertiary hospitals in Melbourne with acute low back pain, migraine, or ankle sprain, and with a pain score on a 10‐point verbal numerical rating scale (VNRS) of at least 4. Main outcome measures: The primary outcome measure was pain at one hour (T1). Clinically relevant pain relief was defined as achieving a VNRS score below 4, and statistically relevant pain relief as a reduction in VNRS score of greater than 2 units. Results: 1964 patients were assessed between January 2010 and December 2011; 528 patients with acute low back pain (270 patients), migraine (92) or ankle sprain (166) were randomised to acupuncture alone (177 patients), acupuncture plus pharmacotherapy (178) or pharmacotherapy alone (173). Equivalence and non‐inferiority of treatment groups was found overall and for the low back pain and ankle sprain groups in both intention‐to‐treat and per protocol (PP) analyses, except in the PP equivalence testing of the ankle sprain group. 15.6% of patients had clinically relevant pain relief and 36.9% had statistically relevant pain relief at T1; there were no between‐group differences. Conclusion: The effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy. Acupuncture is a safe and acceptable form of analgesia, but none of the examined therapies provided optimal acute analgesia. More effective options are needed. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12609000989246.

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Section: Venipuncture and Intravenous Cannulationmentioning

confidence: 99%

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

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“…Pain Ease Ò is a vapocoolant spray that acts in less than a minute; it contains 1,1,1,3,3-pentafluoropropane and 1,1,1,2-tetrafluoroethane and was shown in an RCT to reduce intravenous cannulation-related pain in children aged 6-12 years and to improve the success rate of cannulations [115]. Pain Ease Ò was preferred to ice applications prior to intravenous cannulations in children in one small study [116].…”

Section: Topical Anestheticsmentioning

confidence: 99%

Managing Pediatric Pain in the Emergency Department

Bailey

Trottier

2016

Pediatr Drugs

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Far more attention is now given to pain management in children in the emergency department (ED). When a child arrives, pain must be recognized and evaluated using a pain scale that is appropriate to the child's development and regularly assessed to determine whether the pain intervention was effective. At triage, both analgesics and non-pharmacological strategies, such as distraction, immobilization, and dressing should be started. For mild pain, oral ibuprofen can be administered if the child has not received it at home, whereas ibuprofen and paracetamol are suitable for moderate pain. For patients who still require pain relief, oral opioids could be considered; however, many EDs have now replaced this with intranasal fentanyl, which allows faster onset of pain relief and can be administered on arrival pending either intravenous access or definitive care. Intravenous opioids are often required for severe pain, and paracetamol or ibuprofen can still be considered for their likely opioid-sparing effects. Specific treatment should be used for patients with migraine. In children requiring intravenous access or venipuncture, non-pharmacological and pharmacological strategies to decrease pain and anxiety associated with needle punctures are mandatory. These strategies can also be used for laceration repairs and other painful procedures. Despite the gaps in knowledge, pain should be treated with the most up-to-date evidence in children seen in EDs.

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“…However, the topical anesthetic wears off very quickly, but this should not be a problem since it can be reapplied as often as needed. A randomized controlled study in the pediatric emergency department at a Canadian Children's hospital documented a significant decrease in pain (mean difference 19 mm, 95 % CI 6-32 mm on NRS, p \ 0.01) with the use of the vapocoolant Pain-Ease compared to a placebo spray and a greater first attempt intravenous cannulation success rate (85 vs. 62.5 % for the placebo spray, 95 % CI 3.2-39.9 %, p = 0.03) with a number needed to treat to prevent 1 cannulation failure was 5 (95 % CI 3-32) [38]. The vapocoolants may be associated with minimal erythema or blanching of the skin in some patients which resolves in \5 min [37].…”

Section: Needle-free Injectablesmentioning

confidence: 99%

Pediatric Pain and Anxiety in the Emergency Department: An Evidence-Based Approach to Creating an Anti-Pain Environment

Avarello

Rocker

Tanweer

2016

Curr Emerg Hosp Med Rep

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There have been real advances in the area of pain and anxiety management in pediatric patients in the urgent and emergent settings. The focus on the ''patient experience'' and not just the obtaining of a diagnosis and a treatment has forced many Emergency Departments to reassess how they address pain and anxiety. Many new products and methods, whether pharmacological based or not, are being utilized to make the patient encounter less stressful and less painful for both children and families. Additionally, it has been recognized that appreciating the importance of the patient's developmental age is essential in choosing the correct modality of intervention. Yet again, we learn children are not just small adults.

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The effect of vapocoolant spray on pain due to intravenous cannulation in children: a randomized controlled trial

Cited by 93 publications

References 30 publications

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Managing Pediatric Pain in the Emergency Department

Pediatric Pain and Anxiety in the Emergency Department: An Evidence-Based Approach to Creating an Anti-Pain Environment

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