Comparison of the Effectiveness of EMLA Cream, 2% Lidocaine Gel, and Ice Bag on Pain Intensity Caused by Venipuncture in Children Aged 6-12 Years

Document Type : Original Article

Authors

1 Nursing Department - Shoushtar Medical School - Shoushtar - Iran

2 Master of Nursing, Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Ahvaz University of Medical Sciences, Ahwaz, Iran.

3 PhD of Nursing, Department of Mental Nursing, Chronic Disease Care Research Center, Faculty of Nursing and Midwifery; Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

4 PhD of Nursing, Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Ahvaz University of Medical Sciences, Ahwaz, Iran.

5 Master of Biostatistics, Department of Health, Shoushtar Faculty of Medical Sciences, Shoushtar, Iran

10.22118/jsmj.2024.435661.3375

Abstract

Background and Objectives Intravenous catheter placement is one of the most common invasive care measures performed by nurses. Considering the contradictory results obtained regarding the effect of local analgesic techniques, the present study was conducted to compare the effect of EMLA cream vs. 2% lidocaine gel vs. ice bag on pain intensity caused by venipuncture in children aged 6-12 years. Subjects and Methods In this clinical trial, 160 children undergoing elective surgery were selected according to the inclusion and exclusion criteria and were divided into 4 groups of 40 using block randomization method. In this study, pain intensity was measured based on patient self-report and by nurses during venipuncture while applying EMLA cream, 2% lidocaine gel, and ice bag using the numeric analog scale (NAS) and the FLACC scale which included 5 criteria for child behavior. The range of scores in both scales is recorded from 0 to 10, where 0 indicates absence of pain. The data were collected using dispersion indices. Kruskal-Wallis test and chi-square test were used to compare the numerical scale of pain and behavior between groups using SPSS-16 statistical software. Results The mean age of the participants was 7.79±1.79 years, and 80 (50%) were male. The results showed that the mean values of pain intensity based on the numerical scale in the control, EMLA cream, lidocaine gel, and ice bag group were 4±0.78, 0.9±0.75, 2.80±0.18, and 2.60±0.67, respectively. Moreover, there was a statistically significant difference between the groups according to numerical scale and behavioral scale (P<0.001), with the EMLA cream group expressing a lower level of pain based on both scales. Conclusion The results of the present study showed that the use of all three methods of EMLA cream, lidocaine gel, and ice bag reduced pain during venipuncture. The EMLA cream was associated with a higher amount of pain reduction compared to the other two methods. Therefore, EMLA cream could be recommended to be used routinely in the target area one hour before catheter placement.

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[1] Remziye Semerci, ÖzlemAkarsu, Derya Kılıç. The effect of buzzy and cold spray on pain, anxiety, and fear of children during venipuncture in pediatric emergency department in Turkey; A randomized controlled study. Journal of Pediatric Nursing, 2023; 68: e1-e7. [10.1016/j.pedn. 2022.08.019] [PMID] [2] Monika I Hasenbring , Omar Chehadi, Christina Titze, Nina Kreddig. Fear and anxiety in the transition from acute to chronic pain: There is evidence for endurance besides avoidance Pain Management,2014 ;4(5), 363–374. [10.2217/ pmt.14.36 ] [PMID] [3] Debra Ann Potts , Katherine Finn Davis , Okan U Elci , Joel A Fein. A Vibrating Cold Device to Reduce Pain in the Pediatric Emergency Department: A Randomized Clinical Trial. Pediatric Emergency Care,2019; 35(6), 419–425. [10.1097/PEC.0000000 000001041 ] [PMID] [4] Franca Benini, Antonio F. Urbino, Emilio Fossali, Rossella Letizia Mancusi, Gregorio P. Milani.Pain management in children has significantly improved in the Italian emergency departments. Acta Paediatrica, 2020; 109(7), 1445–1449. [10. 1111/apa.15137 ] [PMID] [5] Remziye Semerci , Esra Nur Kocaaslan , Melahat Akgün Kostak ,
Nefise Akın. Çocuklarda damar yolu açma işlemi sırasında oluşan ağrıyı azaltma: Buzzy uygulaması. Ağrı,2020 ;32(4), 177–185. [ 10.14744/agri.2020.02223] [PMID]
[6] Bárbara Vitória Mendes, Maryana da Silva Furlan, Mariana
Bucci Sanches. Non-pharmacological interventions in painful needle procedures in children: integrative review. BrJP. São Paulo, 2022;5(1):61-7. [Link]
[7] Cho Lee Wong, Miranda Mei Wa Lui, and Kai Chow Choi. Effects of immersive virtual reality intervention on pain and anxiety among pediatric patients undergoing venipuncture: a study protocol for a randomized controlled trial. Trials ,2019; 20:369 [10.1186/s13063-019-3443-z] [PMID] [8] Babamohamadi H, Ameri Z, Asadi I, Asgari MR. Comparison of the Effect of EMLA™ Cream and the Valsalva Maneuver on Pain Severity during Vascular Needle Insertion in Hemodialysis Patients: A Controlled, Randomized, Clinical Trial. Evid Based Complement Alternat Med, 2022; 31(2022):1-7. [10.1155/ 2022/8383021 ] [PMID] [9] BehzadAliakbari Sharabiani, Daryosh Sheikhzadeh, Sina Parsay, Hossein Razmi, Mahin Seyedhejazi. A comparison of the impact of time on the analgesic efficacy of emla cream application in children undergoing venipuncture: A randomized controlled trial. Perioperative Care and Operating Room Management, 2020; 21: 100131. [ Link] [10] Shahid S, Florez ID, Mbuagbaw L. Efficacy and Safety of EMLA Cream for Pain Control Due to Venipuncture in Infants: A Meta-analysis. Pediatrics, 2019;143(1):e20181173. [10.1542/peds. 2018-1173 [PMID] [11] Morteza Ghojazadeh, Sarvin Sanaie, Zahra Parsian, Roya Najafizadeh, Hassan Soleimanpour. Use of Lidocaine for Pain Management in the Emergency Medicine: A Systematic Review and Meta-Analysis. Pharmaceutical Sciences September 2019, 25(3), 177-183.[Link] [12] Ravanshad Y, Golsorkhi M, Ravanshad S, Azarfar A, Esmaeeli M, Ghodsi A. Analgesia for Pediatric Arteriovenous Fistula Cannulation in Hemodialytic Patients: A Comparison of Lidocaine Gel, Lidocaine Spray, and Needle Plate. Indian J Nephrol, 2021;31(4):349-352. [10.4103/ijn.IJN_151_20] [PMID]. [13] Alalo FMA, Ahmad AES, El Sayed HMN. Pain Intensity after an Ice Pack Application Prior to Venipuncture among School-Age Children: An Experimental Study. Journal of Education and Practice, 2016;7(36):16-25.[Link] [14] Matsumoto T, Chaki T, Hirata N, Yamakage M. The eutectic mixture local anesthetics (EMLA) cream is more effective on venipuncture pain compared with lidocaine tape in the same patients. JA Clin Rep, 2018;4(1):73. [10.1186/s40981-018-0210-1] [PMID]. [15] Jinhee Shin, Gwang Suk Kim, Hyebeen Sim . Comparing the effectiveness of three pain relief methods for inserting a needle into the implanted venous access chemoport: A randomized controlled trial. International Journal of Nursing Practice, 2022; 28(4): e12974. [ 10.1111/ijn.12974 ] [PMID]. [16] Mirzaei S, Javadi M, Eftekhari A, Hatami M, Hemayati R. Investigation of the effect of EMLA cream, lidocaine spray, and ice pack on the arteriovenous fistula cannulation pain intensity in hemodialysis patients. International Journal of Medical Research & Health Science, 2018;7(2):51-7.[Link] [17] Gerardo Olivella, David Deliz-Jimenez, Eduardo Lindsay, Edwin Burgos-Rossy, Natalia Torres-Acevedo, Daniela Ramírez-Roggio, et al. Assessing need for advance imaging among children with back pain using pain intensity as clinical marker. Journal of Children's Orthopaedics, 2022;16(6): 461-465. [10.1177/18632521221137392] [PMID]. [18] Lempinen H, Pölkki T, Kyngäs H, Kaakinen P. Feasibility and Clinical Utility of the Finnish Version of the FLACC Pain Scale in PICU. J Pediatr Nurs, 2020;55:211-216. [10.1016/j.pedn.2020. 07.011 ] [PMID]. [19] Dasarraju RK, SVSG N. Comparative efficacy of three topical anesthetics on 7-11-year-old children: a randomized clinical study. J Dent Anesth Pain Med. 2020;20(1):29-37. [10.17245/ jdapm.2020.20.1.29] [PMID] [20] Dasarraju RK, Svsg N. Comparative efficacy of three topical anesthetics on 7-11-year-old children: a randomized clinical study. J Dent Anesth Pain Med, 2020;20(1):29-37. [10.17245/ jdapm.2020.20.1.29 ] [PMID]. [21] Farnia F, Zeighamian S, Dehghani Kh, Lotfi H. Comparison the Effect of Emla cream and cold compress on the pain intensity of Enoxaparin injection.Community Health journal 2014;8(2): 39-46.[Link]. [22] Arab V, Bagheri-Nesami M, Mousavinasab SN, Espahbodi F, Pouresmail Z. Comparison of the Effects of Hegu Point Ice Massage and 2% Lidocaine Gel on Arteriovenous Fistula Puncture-Related Pain in Hemodialysis Patients: A Randomized Controlled Trial. J Caring Sci, 2017 1;6(2):141-151. [10.15171/ jcs.2017.014 ] [PMID]. [23] Javadi M, Mirzaei S, Eftekhari A. Study of the effect of EMLA cream and ice pack on the pain of vascular needles insertion in hemodialysis patients. Journal of Shahid Sadoughi University of Medical Sciences, 2019; 26 (8) :694-705. [Link] [24] Gupta J, Khunger N, Ramesh V. Comparative study of three different modalities of topical anesthesia in various dermatological procedures. Indian Journal of Drugs in Dermatology, 2020; 6.1: 22. [ Link]
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Hemmatipour A, et al. Comparison of the Effectiveness of EMLA Cream, 2% Lidocaine Gel, and Ice Bag. JSMJ. 2024; 22(6):743-756
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[25] Fujimoto K, Adachi H, Yamazaki K, Nomura K, Saito A, Matsumoto Y, et al. Comparison of the pain-reducing effects of EMLA cream and of lidocaine tape during arteriovenous fistula puncture in patients undergoing hemodialysis: A multi-center, open-label, randomized crossover trial. Plos one. 2020;15(3):e0230372.[10.1371/journal.pone.0230372][PMID] [26] Nikfarid L, GHAMAR YR, Namazian M, Namdar F, Azam NM. Comparison of emla cream versus local refrigeration for reducing venipuncture-related pain in pediatric patients of children’s medical center 2008. Iranian Journal of Nursing Research. 2010; 5 (16): 32-37.[Link] [27] Farnia F, Zeighamian S, Dehghani K, Lotfi H. Comparison of the Effect of Emla cream and Cold Compress on the Pain Intensity of Enoxaparin injection. Community Health Journal. 2014;8(2):39-46.[link] [28] Alsantali A. A comparative trial of ice application versus EMLA cream in alleviation of pain during botulinum toxin injections for palmar hyperhidrosis. Clin Cosmet Investig Dermatol, 2018; 3;11:137-140. [10.2147/CCID.S155023 ] [PMID]. [29] Hogan ME, Smart S, Shah V, Taddio A. A systematic review of vapocoolants for reducing pain from venipuncture and venous cannulation in children and adults. J Emerg Med, 2014; 47(6):736-49. [10.1016/j.jemermed.2014.06.028 ] [PMID]