Brief focal ultrasound with topical anesthetic decreases the pain of intravenous placement in children.
OBJECTIVE
To determine whether brief, focal pretreatment of children's skin with low-frequency ultrasound followed by a 5-minute application of a 4% lidocaine topical anesthetic decreases the pain of intravenous (IV) catheter placement.


METHODS
A randomized, double-blind, placebo-controlled trial enrolling children 8 to 18 years of age undergoing IV placement as part of their care in a pediatric emergency department. Thirty-eight children received pretreatment followed by 5-minute application of a topical anesthetic. Thirty-nine children received pretreatment followed by 5-minute application of a placebo cream. Children and parents rated the pain associated with IV placement using the visual analog scale (VAS).


RESULTS
There were no significant differences in demographics between the 2 groups. Children in the treatment group had significantly lower VAS scores (mean, 2.29) than children in the control group (mean, 3.23) (P = 0.023; 95% confidence interval of the mean difference, -1.87 to -0.02). The parents' VAS scores of the child's pain were also lower for the treatment group (mean, 2.47 vs 3.39; P = 0.038; confidence interval, -1.97 to 0.11).


CONCLUSIONS
Visual analog scale scores measuring children's pain and parents' perception of the child's pain were lower in those who were pretreated with brief focal ultrasound and 5 minutes of 4% lidocaine cream when compared with those pretreated with ultrasound and placebo.
Skarbek-Borowska
Sara
S
Department of Emergency Medicine, Rhode Island Hospital, Providence, RI 02903, USA.
Becker
Bruce M
BM
Lovgren
Kirsten
K
Bates
Adriana
A
Minugh
P Allison
PA
D000287:Administration, Topical; D000293:Adolescent; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001291:Attitude of Health Personnel; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D002648:Child; D003131:Combined Modality Therapy / Q000379:methods; D004311:Double-Blind Method; D016529:Emergency Nursing / Q000379:methods; D004890:Erythema / Q000209:etiology; D006801:Humans; D007262:Infusions, Intravenous; D008012:Lidocaine / Q000008:administration & dosage*; D010146:Pain / Q000175:diagnosis / Q000209:etiology*; D059408:Pain Management; D010147:Pain Measurement; D017060:Patient Satisfaction; D010372:Pediatrics / Q000379:methods; D011446:Prospective Studies; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*
D000779:Anesthetics, Local; D008012:Lidocaine