From the pre-hospital literature: needle-free delivery of 0.5mg lidocaine before venepuncture considerably reduces pain in paediatric patients

摘要

Needle-free delivery of 0.5 mg lidocaine before venepuncture considerably reduces pain in paediatric patients ▸\ud▴ Migdal M, Chudzynska-Pomianowska E, Vause E, et al. Rapid, needle-free delivery of lidocaine for reducing the pain of venipuncture among paediatric subjects. Paediatrics2005;115:393–8.\ud\udNeedle insertion and intravenous cannulation have been found to be a painful and frightening experience for children. This double-blind, randomised, placebo-controlled study compared the delivery of 0.5 mg lidocaine, 0.25 mg lidocaine and placebo in 144 paediatric patients undergoing venepuncture through a single-use, needle-free drug delivery system (ALGRX 3268, AlgoRx Pharmaceuticals, Secaucus, New Jersey, USA). This system administers powdered drug into the epidermis for inducing local anaesthesia in 2–3 min. Pain scores were measured using the Faces Pain Scale Revised (FPS-R) and Visual Analogue Scale (VAS). A significant reduction was observed in mean VAS pain scores of –0.428 in the 3–7-year-old group of patients treated with 0.5 mg lidocaine compared with placebo (95% confidence interval (CI) –0.834 to –0.022). The reduction in pain for patients treated with 0.25 mg lidocaine was not significant. It was concluded the needle-free drug delivery system configured to deliver 0.5 mg lidocaine reduces the pain of venepuncture at the antecubital fossa rapidly, safely and effectively. Although this device might be of value in the prehospital environment, the reduction in the VAS pain score was small and it is unclear whether this represents a change of significant magnitude for patients to perceive an actual benefit. Further, the validity of the VAS in young children is uncertain. Further research is required to prove its clinical benefit.