Ointment Eases Pain for Kids Getting An IV

NEWYORK (Reuters Health) - An anesthetic ointment, a formulation of lidocaine, reduces pain for children having an intravenous needle inserted or having blood drawn. It also improves the rate of successful insertions and reduces procedure time, according to Canadian investigators.

"Although studies have already previously shown that topical local anesthetics decrease pain during procedures when the skin is punctured by a needle," Dr. Anna Taddio told Reuters Health, "there was a belief that (anesthetics) interfered with completing the procedures themselves."

She explained, "It was argued that there was no point decreasing the child's pain if it resulted in failed procedures."

The problem is that lidocaine constricts blood vessels, and in cream form it takes 60 minutes to work. However, lidocaine encapsulated in microscopic lipid spherules called liposomes is faster acting and has little effect on blood vessels.

Taddio, of the Hospital for Sick Children in Toronto, and colleagues examined whether liposomal lidocaine cream improved the success rate of needle insertions in 142 children, ranging in age from 1 month to 17 years.

Pain was evaluated using a standard measure before and after the procedure attempt by the child, parents, and research assistant if the child was 5 years or older. In those younger than 5, pain was evaluated by the parents and research assistant.

The team also recorded the total duration of the procedure as well as any adverse skin reactions.

The success rate on the first insertion attempt was significantly higher among the children who were pre-treated with liposomal lidocaine ointment than among treated children with an inactive "placebo" cream (74 percent versus 55 percent), the researchers report in the Canadian Medical Association Journal.

Among children at least 5 years of age, those who received liposomal lidocaine reported lower average pain scores. The parents and research assistant reported lower average pain scores for all children who received liposomal lidocaine than for those who were treated with a placebo cream.

The average total procedure duration was shorter among those who received liposomal lidocaine than among those who received placebo -- 6.7 minutes versus 8.5 minutes, respectively.

The investigators note that because pain during needle puncture was reduced, the children moved less during needle placement and this facilitated the procedure.

Overall, 23 percent of patients in both groups reported short-lived skin reactions.

Liposomal lidocaine "should be used routinely" for children undergoing these types of procedures, Taddio concluded.

"It benefits everyone; it decreases pain in children, and results in less number of pokes and a shorter procedure time," she noted. "This results in decreased stress for children, parents, and the healthcare workers performing the procedures."

SOURCE: Canadian Medical Association Journal, June 21, 2005.