title: Routine immunization practices: use of topical anesthetics and oral analgesics.
abstract: BACKGROUND
  Immunization pain is a global public health issue. Despite an abundance of data that demonstrate the efficacy of local anesthetics for decreasing immunization pain, their adoption in practice has not been determined. Our objective was to evaluate analgesic use during childhood immunization.
  
  
  METHODS
  We used a cluster-sampling survey of pediatricians in the greater Toronto area (who administer immunizations) and multiparous women. By using a self-administered survey, pediatricians reported frequency of analgesic use in their practice for 2 phases of immunization: injection (needle puncture and vaccine administration) and postinjection (hours to days postvaccination). By using an interviewer-administered face-to-face survey, mothers reported analgesic practices for their children.
  
  
  RESULTS
  Of 195 eligible pediatricians, 140 (72%) responded. During the injection phase, 58% rarely or never used analgesics compared with 11% for the postinjection phase. During injection, the local anesthetics lidocaine-prilocaine and tetracaine were used at least sometimes in 12% and 2% of the practices, respectively, whereas acetaminophen and ibuprofen were used in 81% and 46%, respectively. Postinjection, acetaminophen and ibuprofen were used in 89% and 56% of practices. Of 257 eligible mothers, 200 (78%) participated. During injection, analgesics were used in 25% of immunizations (acetaminophen [87%], ibuprofen [7%], and lidocaine-prilocaine [6%]). Postinjection, analgesics were used in 33% of immunizations (acetaminophen [86%] and ibuprofen [14%]).
  
  
  CONCLUSIONS
  A minority of pediatricians and mothers use topical local anesthetics during childhood immunization despite evidence to support their use. Oral analgesics are used more commonly, but this practice is not consistent with scientific evidence. Knowledge-translation strategies are needed to increase the use of local anesthesia.
authors.affiliation: Department of Pharmacy, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8. anna.taddio@sickkids.ca
authors.forename: Anna
authors.initials: A
authors.lastname: Taddio
authors.forename: Jennifer
authors.initials: J
authors.lastname: Manley
authors.forename: Leah
authors.initials: L
authors.lastname: Potash
authors.forename: Moshe
authors.initials: M
authors.lastname: Ipp
authors.forename: Michael
authors.initials: M
authors.lastname: Sgro
authors.forename: Vibhuti
authors.initials: V
authors.lastname: Shah
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000284:Administration, Oral; D000287:Administration, Topical; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use; D007407:Interviews as Topic; D008012:Lidocaine / Q000627:therapeutic use; D016014:Linear Models; D008297:Male; D009035:Mothers; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011318:Prilocaine / Q000627:therapeutic use; D012494:Sampling Studies; D011795:Surveys and Questionnaires; D013748:Tetracaine / Q000627:therapeutic use; D014612:Vaccines / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D018712:Analgesics, Non-Narcotic; D000779:Anesthetics, Local; D014612:Vaccines; D011318:Prilocaine; D013748:Tetracaine; D000082:Acetaminophen; D008012:Lidocaine; D007052:Ibuprofen