title: First-time success with needle procedures was higher with a warm lidocaine and tetracaine patch than an eutectic mixture of lidocaine and prilocaine cream.
abstract: OBJECTIVE
  More than 50% of children report apian during venepuncture or intravenous cannulation and using local anaesthetics before needle procedures can lead to different success rates. This study examined how many needle procedures were successful at the first attempt when children received either a warm lidocaine and tetracaine patch or an eutectic mixture of lidocaine and prilocaine (EMLA) cream.
  
  
  METHODS
  We conducted this multicentre randomised controlled trial at three tertiary-level children's hospitals in Italy in 2015. Children aged three to 10 years were enrolled in an emergency department, paediatric day hospital and paediatric ward and randomly allocated to receive a warm lidocaine and tetracaine patch or EMLA cream. The primary outcome was the success rate at the first attempt.
  
  
  RESULTS
  The analysis included 172 children who received a warm lidocaine and tetracaine patch and 167 who received an EMLA cream. The needle procedure was successful at the first attempt in 158 children (92.4%) who received the warm patch and in 142 children (85.0%) who received the cream (p = 0.03). The pain scores were similar in both groups.
  
  
  CONCLUSIONS
  This study showed that the first-time needle procedure success was 7.4% higher in children receiving a warm lidocaine and tetracaine patch than EMLA cream.
authors.affiliation: Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Cozzi
authors.affiliation: Pediatric Pain Service and Palliative Care, Department of Oncology, Pausilipon Hospital, AORN Santobono Pausilipon, Naples, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Borrometi
authors.affiliation: Department of Women's and Children's Health, University of Padua, Padua, Italy.
authors.forename: Franca
authors.initials: F
authors.lastname: Benini
authors.affiliation: Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Neri
authors.affiliation: Department of Women's and Children's Health, University of Padua, Padua, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Rusalen
authors.affiliation: Pediatric Pain Service and Palliative Care, Department of Oncology, Pausilipon Hospital, AORN Santobono Pausilipon, Naples, Italy.
authors.forename: Loredana
authors.initials: L
authors.lastname: Celentano
authors.affiliation: Pharmacy and Clinical Pharmacology Unit, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Zanon
authors.affiliation: Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.
authors.forename: Silvana
authors.initials: S
authors.lastname: Schreiber
authors.affiliation: Clinical Epidemiology and Health Services Research Unit, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Ronfani
authors.affiliation: Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.
authors.forename: Egidio
authors.initials: E
authors.lastname: Barbi
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage*; D002406:Catheterization, Peripheral / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D006358:Hot Temperature; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D000077442:Lidocaine, Prilocaine Drug Combination; D008297:Male; D010146:Pain / Q000517:prevention & control*; D018962:Phlebotomy / Q000009:adverse effects*; D011318:Prilocaine / Q000008:administration & dosage*; D013748:Tetracaine / Q000008:administration & dosage*
chemical_list: D000779:Anesthetics, Local; D000077442:Lidocaine, Prilocaine Drug Combination; D011318:Prilocaine; D013748:Tetracaine; D008012:Lidocaine
keywords: Eutectic mixture of lidocaine and tetracaine cream; Local anaesthetic; Needle procedure; Procedural success rate; Warm lidocaine and tetracaine patch