title: Pain reduction in children during port-à-cath catheter puncture using local anaesthesia with EMLA™.
abstract: BACKGROUND
  Alleviating pain is of high importance for children undergoing chemotherapy. Eutectic mixture of lidocain-prilocain cream (EMLA) is assumed to require 60 min application time.
  
  
  METHODS
  We prospectively compared the pain during port-à-cath punctures after 40 min compared to 60 min of application time. A prospective, unblinded, cross-over study was performed. The children received two punctures during their chemotherapy protocol. Patients in group 1 had the first puncture after 40 min EMLA application time. Their second puncture (approximately a week later) was done after 60 min. Patients in group 2 started after 40 min. Pain was scored using the visual analogue scale (VAS) and the Bieri scale. Patients, parents and a nurse scaled the pain after the intervention. Eighty-seven children between 2 and 18 years with different malignant diseases were included.
  
  
  CONCLUSIONS
  On the VAS pain scale, the mean pain was 2.3 (minimum 0, maximum 9.2) after 40 min and 1.9 (minimum 0, maximum 9.4) after 60 min according to the observations of the nurse and very similarly according to the parents' observations. The children expressed more pain after 40 min of EMLA application time (mean pain, 3.5) and a significant pain reduction after 60 min application time (mean pain 1.7).
  
  
  CONCLUSIONS
  In this study children experienced less pain after 60 min application time, but pain reduction was already seen after 40 min. The child's perception of pain differed from observers' point of view and should therefore always be included in pain management.
authors.affiliation: Department of Paediatric Haematology and Oncology, Medical University, Hannover, Germany.
authors.forename: Birke
authors.initials: B
authors.lastname: Lüllmann
authors.forename: Johannes
authors.initials: J
authors.lastname: Leonhardt
authors.forename: Martin
authors.initials: M
authors.lastname: Metzelder
authors.forename: Ludwig
authors.initials: L
authors.lastname: Hoy
authors.forename: Heidrun
authors.initials: H
authors.lastname: Gerr
authors.forename: Christin
authors.initials: C
authors.lastname: Linderkamp
authors.forename: Christoph
authors.initials: C
authors.lastname: Klein
authors.forename: Lorenz
authors.initials: L
authors.lastname: Grigull
mesh_terms: D000293:Adolescent; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000379:methods; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D004358:Drug Therapy / Q000295:instrumentation; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D000077442:Lidocaine, Prilocaine Drug Combination; D008297:Male; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement / Q000379:methods; D058748:Pain Perception / Q000187:drug effects*; D017288:Pain Threshold / Q000187:drug effects; D011318:Prilocaine / Q000008:administration & dosage*; D011446:Prospective Studies; D011677:Punctures / Q000009:adverse effects* / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D000077442:Lidocaine, Prilocaine Drug Combination; D011318:Prilocaine; D008012:Lidocaine