Comparison of EMLA and lidocaine iontophoresis for cannulation analgesia

Moppett, I. K.; Szypula, K.; Yeoman, P

doi:10.1017/s0265021504003084

Cited by 19 publications

(8 citation statements)

References 14 publications

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“…The primary outcome, pain, was measured in a variety of ways including: a visual analogue scale (VAS) ( n = 22 studies [ 1 , 14 – 17 , 27 , 30 – 32 , 35 , 37 , 39 – 41 , 43 , 44 , 46 – 49 , 51 – 53 , 56 ]), a numerical rating scale ( n = 6, [ 13 , 29 , 34 , 38 , 50 , 54 ]), Wong Baker Faces ( n = 1, [ 28 ]) and, other ( n = 4 [ 30 , 33 , 36 , 45 ]). Four studies reported that participants had been given pre-medication prior to PVC [ 29 , 42 , 45 , 47 ].…”

Section: Resultsmentioning

confidence: 99%

First do no harm: pain relief for the peripheral venous cannulation of adults, a systematic review and network meta-analysis

et al. 2015

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BackgroundPeripheral venous cannulation is an everyday practice in hospitals, which many adults find painful. However, anaesthesia for cannulation is usually only offered to children. Inadequate pain relief is not only unpleasant for patients but may cause anxiety about further treatment and deter patients from seeking medical care in the future. The aim of this study is to discover the most effective local anaesthetic for adult peripheral venous cannulation and to find out how the pain of local anaesthetic application compares with that of unattenuated cannulation.MethodsThese aims are addressed through a systematic review, network meta-analysis and random-effects meta-analysis. Searching covered 12 databases including MEDLINE and EMBASE from 1990 to August 2015. The main included study design was RCTs. The primary outcome measure is self-reported pain, measured on a 100 mm visual analogue scale.ResultsThe systematic review found 37 includable studies, 27 of which were suitable for network meta-analysis and two for random-effects meta-analysis. The results of the network meta-analysis indicate that none of the 17 anaesthetic considered had a very high probability of being the most effective when compared to each other; 2 % lidocaine had the highest probability (44 %). When the anaesthetics were compared to no treatment, the network meta-analysis showed that again 2 % lidocaine was estimated to be the most effective (mean difference −25.42 (95 % CI −32.25, −18.57). Other members of the ‘caine’ family were also estimated to be more effective than no treatment as were Ametop®, EMLA® and Rapydan® patch. The meta-analysis compared the pain of anaesthetic application with the unattenuated pain of cannulation. This found that all applications of local anaesthetic were less painful than cannulation without local anaesthetic. In particular a 1 % lidocaine injection was estimated to be −12.97 (95 % CI −15.71, −10.24) points (100 mm VAS) less painful than unattenuated cannulation.ConclusionsThe pain of peripheral venous cannulation in adults can be successfully treated. The pain of application of any local anaesthetic is less than that of unattenuated cannulation. Local anaesthetic prior to cannulation should become normal practice and a marker of high quality care.Protocol registrationThe protocol for the larger study was registered with PROSPERO no. CRD42012002093.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-016-0252-8) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

First do no harm: pain relief for the peripheral venous cannulation of adults, a systematic review and network meta-analysis

et al. 2015

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“…[75][76][77][78] There is some evidence that a 15-minute application of lidocaine iontophoresis works as well as an hour-long application of lidocaine/prilocaine cream or the less desirable lidocaine infiltration. [79][80][81][82] The final, needle-free delivery method commonly used is pressurized gas, which creates an ultra-fine stream of medication that penetrates the skin (J-Tip, National Medical Products). For analgesia prior to venous access, the syringe is loaded with buffered lidocaine (preloaded syringes can be purchased), and the device is placed firmly against the skin.…”

Section: Discussionmentioning

confidence: 99%

Emerging Therapies in Pediatric Pain Management

Mosiman

Pile

2013

Journal of Infusion Nursing

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“…31,32 It has compared favorably with EMLA and injectable lignocaine in randomized trials. 33 Its advantage is that it only takes about 10 to 15 minutes to be effective. Disadvantages are the need for specific equipment and side effects of a burning sensation, erythema or blistering and the fear that small children exhibit toward the device.…”

Section: Iontophoresismentioning

confidence: 99%

Alternatives to Sedation for Painful Procedures

Barnett

2009

Pediatric Emergency Care

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Conscious sedation is used frequently to perform procedures that may be undertaken with or without minimal sedation. Fracture manipulation can be performed with minimal discomfort in the awake patient using various techniques-for example, intravenous regional anesthesia, nerve blocks, and hematoma blocks. These have been used for many years and are very safe. They may require some specific equipment (eg, automatic tourniquet) to perform the anesthesia but patients have the same results and are able to go home much quicker because sedation is not used.Use of topical anesthesia for both intact skin and wounds has been used over many years. Its use now should be standard. Nerve blocks can also be used to anesthetize specific areas which may be difficult to use topical anesthesia (eg, lip, hand, etc) or are painful because of injection directly into the wound. These may include infraorbital nerve blocks for lip lacerations, ulna or median nerve blocks for hand injuries, and so on. Other novel approaches to topical anesthesia have seen the use of iontophoresis (again requires specific expensive equipment), jet injection of lidocaine, or "freeze sprays." Each has its own advantages and disadvantages.Femoral nerve block is a useful intervention for analgesia in patients with femoral fractures and can obviate the need for parenteral analgesia and allows excellent analgesia particularly during x-ray examination.Thus, it is important to remember that there are alternatives to conscious sedation which gives good analgesia during the procedure and allows the patient to be discharged sooner.

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Comparison of EMLA and lidocaine iontophoresis for cannulation analgesia

Abstract: Although lidocaine iontophoresis is effective more quickly than the eutectic mixture of local anaesthetic cream, the superior quality of analgesia produced by the eutectic mixture in this study should be borne in mind if these treatments are used electively.

Cited by 19 publications

References 14 publications

First do no harm: pain relief for the peripheral venous cannulation of adults, a systematic review and network meta-analysis

First do no harm: pain relief for the peripheral venous cannulation of adults, a systematic review and network meta-analysis

Emerging Therapies in Pediatric Pain Management

Alternatives to Sedation for Painful Procedures

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