title: Cryotherapeutic topical analgesics for pediatric intravenous catheter placement: ice versus vapocoolant spray.
abstract: OBJECTIVE
  Intravenous catheter placement is one of the most common sources of pain for children in inpatient settings. We sought to compare the efficacy of 2 cryotherapeutic treatments for this procedure: vapocoolant spray versus topical ice pack.
  
  
  METHODS
  We prospectively enrolled 95 patients, aged 9 to 18 years, in a pediatric emergency department who required intravenous (IV) catheters as part of their treatment. Subjects were randomly assigned to receive vapocoolant spray or topical ice pack for 3 minutes, before IV catheter placement. Subjects completed visual analog scale (VAS) scores for 3 time points: baseline, pretreatment with ice or spray, and IV insertion. The principal investigator and 2 physicians viewing video recordings of the procedure also completed VAS scores for observed pain levels. Visual analog scale scores were compared using the Wilcoxon rank sum test.
  
  
  RESULTS
  Although median VAS scores were similar, the change in VAS from baseline was of greater magnitude in the Painease group, indicating that it may be more effective. More subjects in the Painease group (76%) felt their treatment worked well, compared with 49% in the ice group. Physician-assigned VAS scores were lower and less variable than those of subjects. Most IV insertions were successful (83%).
  
  
  CONCLUSIONS
  Vapocoolant spray may be more effective than ice as an analgesic for IV insertion. Subjects were more satisfied with vapocoolant spray. Neither agent caused a decrease in successful IV insertion rates.
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027, USA. mwaterhouse@chla.usc.edu
authors.forename: Marie R
authors.initials: MR
authors.lastname: Waterhouse
authors.forename: Deborah R
authors.initials: DR
authors.lastname: Liu
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Wang
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002404:Catheterization / Q000009:adverse effects*; D016009:Chi-Square Distribution; D002648:Child; D017679:Cryotherapy / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006845:Hydrocarbons, Fluorinated; D007053:Ice; D008297:Male; D010146:Pain / Q000209:etiology* / Q000517:prevention & control*; D010147:Pain Measurement; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D014741:Video Recording; D004980:Ethane / Q000031:analogs & derivatives; D005466:Fluorocarbons
chemical_list: D000779:Anesthetics, Local; D006845:Hydrocarbons, Fluorinated; D007053:Ice; C063006:norflurane; D004980:Ethane; D005466:Fluorocarbons; C403631:1,1,1,3,3-pentafluoropropane