title: A comparison of amethocaine and liposomal lidocaine cream as a pain reliever before venipuncture in children: a randomized control trial.
abstract: OBJECTIVE
  Although the use of anesthetic creams before intravenous (IV) insertion has been shown to be both safe and effective in decreasing pain during IV cannulation, the use of any single agent based on efficacy is not yet considered the standard of care in children. We sought to compare a commonly used preparation, 4% liposomal lidocaine (Maxilene), with 4% amethocaine (Ametop), a newer agent with reportedly good efficacy and an intrinsic vasodilatory effect.
  
  
  METHODS
  A total of 60 children aged 5 to 12 years were randomized to receive topically either 4% amethocaine or 4% liposomal lidocaine before IV cannulation. The primary outcome variable was the child's rating of pain using the Faces Pain Scale - Revised. Secondary outcomes included success rate on first IV cannulation attempt, cannulation difficulty ratings by the nurses, and adverse skin reactions.
  
  
  RESULTS
  We found no statistically significant differences in self-reported scores in the Faces Pain Scale-Revised with the use of 4% amethocaine versus 4% lidocaine before IV cannulation. There was a trend toward fewer IV cannulation attempts in the 4% amethocaine group. Adverse skin reactions were uncommon, and there were no statistically significant differences between groups.
  
  
  CONCLUSIONS
  This study demonstrates that there is no difference between 4% amethocaine and 4% liposomal lidocaine in reducing pain associated with IV cannulation in children. Amethocaine confers no advantage in improving IV cannulation success rate over lidocaine. Both agents are associated with few local adverse skin reactions.
authors.affiliation: Department of Pediatrics, Division of Emergency Medicine, Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada. poonai@hotmail.com
authors.forename: Naveen
authors.initials: N
authors.lastname: Poonai
authors.forename: Khalid
authors.initials: K
authors.lastname: Alawi
authors.forename: Michael
authors.initials: M
authors.lastname: Rieder
authors.forename: Tim
authors.initials: T
authors.lastname: Lynch
authors.forename: Rodrick
authors.initials: R
authors.lastname: Lim
mesh_terms: D059787:Acute Pain / Q000209:etiology / Q000517:prevention & control*; D000279:Administration, Cutaneous; D000700:Analgesics / Q000008:administration & dosage* / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004337:Drug Carriers; D003875:Drug Eruptions / Q000209:etiology; D004636:Emergency Service, Hospital; D005260:Female; D006776:Hospitals, Pediatric; D006785:Hospitals, University; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage* / Q000009:adverse effects; D008081:Liposomes; D008297:Male; D009824:Ointments; D010147:Pain Measurement; D018962:Phlebotomy / Q000009:adverse effects* / Q000451:nursing; D013748:Tetracaine / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000700:Analgesics; D000779:Anesthetics, Local; D004337:Drug Carriers; D008081:Liposomes; D009824:Ointments; D013748:Tetracaine; D008012:Lidocaine