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

Accepted ArticleThis article is protected by copyright. All rights reserved. Aim: More than 50% of children report apian during venipuncture 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 3-10 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. Conclusion: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. Accepted ArticleThis article is protected by copyright. All rights reserved.Keywords: eutectic mixture of lidocaine and tetracaine cream; local anaesthetic; needle procedure; procedural success rate; warm lidocaine and tetracaine patch Key notes:• Applying local anesthetics may influence success rates in children undergoing painful needle procedures.• We compared how many needles were inserted at the first attempt when children received a warm lidocaine and tetracaine patch or an eutectic mixture of lidocaine and prilocaine (EMLA) cream.• The three Italian hospitals who took part reported that the success rate was higher in children treated with the warm patch (92.4%) than the cream (85.0%). AbbreviationsARR, absolute risk reduction; CI, confidence intervals; EMLA, eutectic mixture of lidocaine and tetracaine; IQR, interquartile ranges; NNT, number need to treat; RR, relative risks

Comparing the Effect of Lidocaine-Prilocaine Cream and Infiltrative Lidocaine on Overall Pain Perception During Thoracentesis and Abdominocentesis: A Randomized Clinical Trial

“…This study raises the question of whether using LPC in bedridden patients increases attempts to conduct thoracentesis and abdominocentesis compared to patients receiving IL. In a study conducted by Cozzi et al, they showed that the success rate of first attempts in needle procedures was significantly higher in the warm lidocaine-tetracaine patch group than lidocaine-prilocaine cream group (25).…”

A narrative review with practical advice on how to decrease pain and distress during venepuncture and peripheral intravenous cannulation

“…A multicentre study compared 339 children who were prepared with Rapydan for 30 minutes or EMLA for 60 minutes before venepuncture or intravenous catheterisation. They reported that the pain scores were more than 4/10 in about 10% of patients in both groups 42 . The authors also reported that the application of the warm lidocaine/tetracaine patch may cause a local burning or pain sensation which the child finds unconfortable 42 …”

“…Increased successful intravenous catheterisation was achieved when lidocaine cream was compared to a placebo, 36 a warmed lidocaine/tetracaine patch was compared to EMLA 42 and nitrous oxide was compared to oral midazolam 48 . No difference in successful intravenous cannulation was found when buffered lidocaine was compared to a placebo, 24,27 EMLA, 26 vapocoolant 28 or lidocaine cream 25,29 .…”

“…They reported that the pain scores were more than 4/10 in about 10% of patients in both groups. 42 The authors also reported that the application of the warm lidocaine/tetracaine patch may cause a local burning or pain sensation which the child finds unconfortable. 42…”

Eficácia de métodos farmacológicos e não farmacológicos de manejo da dor em crianças durante venipuntura: uma revisão narrativa

“…Também foi utilizada no ensaio de Cozzi et al (2017), onde mostrou-se a eficácia da lidocaína e tetracaína quentes em comparação ao EMLA, obtendo taxa de sucesso maior na primeira tentativa em crianças usando adesivos quentes de lidocaína e tetracaína (92,4%) do que utilizando o creme EMLA (85%). No entanto, ocorreram eventos adversos nos dois grupos, possuindo maior incidência no grupo do adesivo quente (6,4%) do que (3,0%) no grupo do creme EMLA (3,0%), mas é importante ressaltar que foram apenas eventos adversos locais e menores (Cozzi et al, 2017).…”