Source:

Lunoe
MM
,
Drendel
AL
,
Levas
MN
, et al
.
A randomized clinical trial of jet-injected lidocaine to reduce venipuncture pain for young children
.
Ann Emerg Med
.
2015
;
66
(
5
):
466
473
; doi:
https://doi.org/10.1016/j.annemergmed.2015.04.003

Investigators at the Medical College of Wisconsin conducted a randomized controlled trial to determine if needle-free jet-injected lidocaine decreased pain associated with venipuncture. Children 1–6 years old undergoing venipuncture in an outpatient laboratory were randomized to 1 of 3 groups: (1) intervention: jet injection system with buffered lidocaine (J-Tip, which uses air to push lidocaine into the skin to provide local anesthetic quickly) plus a spray of normal saline; (2) control: vapocoolant spray only; or (3) sham: vapocoolant spray plus an empty J-Tip. The entire procedure was videotaped on all study participants. Two investigators blinded to group assignment and each other’s scores reviewed the videos and assigned pain scores using the Face, Legs, Activity, Cry and Consolability (FLACC) tool at 3 time points: prior, during, and after the venipuncture. FLACC is scored from 0–10, with 0 consistent with no pain, 1–3 mild pain, 4–6 moderate pain, and ≥7 severe pain. The primary outcome was change in pain across the 3 time points for each group. Secondary outcomes were success of blood draw on first attempt and adverse events. Families were telephoned at 24 hours to elicit adverse events occurring at home.

Of 346 children screened, 205 were enrolled: 96 received the intervention, 53 were in the control arm, and 56 received a sham injection. Mean age was 3.2 years; 88.8% had experienced a previous venipuncture. Baseline characteristics were similar between the groups.

Pain scores did not significantly increase across the 3 time points for the intervention group (mean change = 0.26; 95% CI, −0.31 to 0.82) but significantly increased for both control (mean change = 2.82; 95% CI, 1.91 to 3.74) and sham (mean change 1.68; 95% CI, 0.83 to 2.52) groups. At venipuncture, 45% of children with J-Tip had no or mild pain compared to 23% in the control group and 30% in the sham group. First attempt venipuncture was successful in 90.7% for all participants with no significant differences between groups. The most common adverse events reported at telephone follow-up were bruising and redness at the site, with no significant differences between groups.

The investigators conclude that J-Tip reduces venipuncture pain in children aged 1–6 years; almost half experienced no or mild pain at venipuncture.

Dr Okada has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Visiting the doctor, whether in the office or emergency department (ED), can be frightening for children; immunizations, drawing blood, and intravenous cannulation are sources of pain and anxiety. Venous access procedures are the most common cause of pain in hospitalized children and the second most common cause of “worst pain.” Hospital guidelines exist for monitoring and treating pain; however, compliance...

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