title: Comparison of the use of the Valsalva maneuver and the eutectic mixture of local anesthetics (EMLA®) to relieve venipuncture pain: a randomized controlled trial.
abstract: OBJECTIVE
  Intravenous cannulation is a painful and stressful procedure. The objective of this study was to compare the analgesic efficacy of the eutectic mixture of local anesthetics (EMLA(®)) with that of the Valsalva maneuver in adult patients during i.v. cannulation.
  
  
  METHODS
  One hundred ninety-five patients were randomized prospectively to three groups. The dorsum of the nondominant hand was covered with a thick paste of 2.5 g of EMLA(®) cream in the EMLA(®) group (group E) and left for a minimum of 30 min before venipuncture. In the control group (group C), the same procedure was applied except that Vaseline(®) was used instead of the EMLA(®). The Valsalva group (group V) were punctured during a Valsalva maneuver. The patients were placed in the supine position during venipuncture. The patients then scored the amount of pain on cannulation using an 11-point numerical rating scale (NRS; 0 = no pain, 10 = extreme pain).
  
  
  RESULTS
  Thirteen patients were excluded from the analysis due to failed cannulation. There was no difference in the demographic profiles of the groups (p > 0.05). The success of VP was significantly higher in group V than in groups E and C (p < 0.001). The median pain score as assessed by the NRS after venipuncture in group C was 3 (range 0-9), whereas the median pain values in groups E and V were 2 (range 0-7) and 2 (range 1-8).
  
  
  CONCLUSIONS
  The Valsalva maneuver yields similar results to the EMLA(®) in terms of pain reduction during venipuncture.
authors.affiliation: Department of Anesthesiology and Reanimation, Medical Faculty, Gaziosmanpasa University, 60300, Tokat, Turkey, mustafasuren@yahoo.com.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Suren
authors.forename: Ziya
authors.initials: Z
authors.lastname: Kaya
authors.forename: Fatih
authors.initials: F
authors.lastname: Ozkan
authors.forename: Unal
authors.initials: U
authors.lastname: Erkorkmaz
authors.forename: Semih
authors.initials: S
authors.lastname: Arıcı
authors.forename: Serkan
authors.initials: S
authors.lastname: Karaman
mesh_terms: D000328:Adult; D019162:Anesthetics, Combined / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002404:Catheterization / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D010146:Pain / Q000188:drug therapy* / Q000517:prevention & control*; D010147:Pain Measurement / Q000379:methods*; D018962:Phlebotomy / Q000009:adverse effects*; D011446:Prospective Studies; D014636:Valsalva Maneuver
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local