Safety, tolerability, and efficacy of iontophoresis with lidocaine for dermal anesthesia in ED pediatric patients.
BACKGROUND
This study examined the safety, tolerability, and efficacy of iontophoresis with 30 mA of lidocaine for dermal anesthesia in children younger than 84 months in the emergency department and the usefulness of a modified version of the Pre-verbal, Early Verbal Pediatric Pain Scale (M-PEPPS).


METHODS
Three expert nurses completed the protocol for iontophoresis and inserted an intravenous catheter. Parents scored pain by using the 10-cm visual analogue scale, nurses used the M-PEPPS, and children, if able, self-reported pain during the procedure and at needle stick.


RESULTS
Serum lidocaine levels were within the normal laboratory reference range. Adverse effects were minor and disappeared prior to discharge from the emergency department. Eighty-five percent of the children had M-PEPPS scores < or=6 during the iontophoresis procedure; 42% had scores of < or =6 at needle stick. Eighty-two percent of the parents marked the vas as < or =30 during the procedure; 65% indicated scores of < or =30 at needle stick. Four children self-reported "a lot of pain" at needle stick. Although low to moderate, M-PEPPS scores and parental pain ratings were significantly correlated at both points in time.


CONCLUSIONS
Iontophoresis with lidocaine is safe for use in young children. It does not create any long-term untoward effects and is quite well tolerated. It is not clear if the higher pain scores at needle stick reflect anxiety and fear of a needle or a painful experience.
Emergency Department, Maine Medical Center, Portland, ME 04102, USA. schula@mmc.org
Alyce A
AA
Schultz
Tania D
TD
Strout
Pam
P
Jordan
Barry
B
Worthing
D000279:Administration, Cutaneous; D000758:Anesthesia; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects* / Q000097:blood; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D007478:Iontophoresis / Q000009:adverse effects*; D008012:Lidocaine / Q000008:administration & dosage* / Q000009:adverse effects* / Q000097:blood; D008297:Male; D010146:Pain / Q000503:physiopathology / Q000517:prevention & control*; D010147:Pain Measurement; D018962:Phlebotomy; D011446:Prospective Studies
D000779:Anesthetics, Local; D008012:Lidocaine