The application of noninvasive local anesthesia for venipuncture in children: a meta-analysis of randomized controlled trials_West China Medical Journal

Authors：

JIANG Yunlan ¹ ,  HU Yue ² , LI Huimin ² , LI Xue ² , ZHOU Ling ² , LI Jianqiong ¹ , WANG Huifang ¹ , YANG Shuyan ¹ , SHEN Yinli ¹ , TANG Xin ¹

1. Department of Nursing, Affiliated Hospital of Chengdu University of TCM, Chengdu, Sichuan 610075, P. R. China;
2. Department of Nursing, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 611731, P. R. China;

Corresponding author：

HU Yue, Email: huxiniao@126.com

Keywords：

Venipuncture; Children; Local anesthesia; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1002-0179.201911132

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Objective To systematically evaluate the efficacy and safety of local anesthesia for venipuncture in children, and to provide evidence for related nursing practice.Methods Web of Science, PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang Data, Chinese Biomedical Database and VIP databases were searched for randomized controlled trials (RCTs) about the application of local anesthesia in venipuncture in children till June 25th, 2021. Two reviewers independently reviewed the literature, extracted data, and assessed the risk of bias of included RCTs. RevMan 5.3 software was used for meta-analysis.Results A total of 19 RCTs were included, comprising 2 566 patients. All of them were high-quality English articles included in SCI or Medline. The results of meta-analysis showed that: the painless rate [odds ratio (OR)=3.80, 95% confidence interval (CI) (1.88, 7.66), P=0.000 2] and satisfaction rate of venipuncture [OR=2.12, 95%CI (1.27, 3.54), P=0.004] in the local anesthesia group were higher than those in the non-anesthesia group, and the pain score [mean difference=−0.62, 95%CI (−0.77, −0.48), P<0.000 01] in the local anesthesia group was lower than that in the non-anesthesia group. There was no statistically significant difference between the two groups in the success rate of the first puncture [OR=1.14, 95%CI (0.77, 1.68), P=0.52], the incidence of transient skin reactions [OR=1.15, 95%CI (0.67, 1.95), P=0.62], the incidence of paleness [OR=1.11, 95%CI (0.57, 2.15), P=0.76], or the incidence of edema at the puncture site [OR=0.64, 95%CI (0.21, 1.96), P=0.44].Conclusions Local anesthesia can effectively reduce pain and improve the satisfaction of children with venipuncture, and has good clinical safety. It can be used by nursing staff in clinical practice.

Citation： JIANG Yunlan, HU Yue, LI Huimin, LI Xue, ZHOU Ling, LI Jianqiong, WANG Huifang, YANG Shuyan, SHEN Yinli, TANG Xin. The application of noninvasive local anesthesia for venipuncture in children: a meta-analysis of randomized controlled trials. West China Medical Journal, 2021, 36(7): 940-948. doi: 10.7507/1002-0179.201911132 Copy

1.	Kennedy RM, Luhmann J, Zempsky WT. Clinical implications of unmanaged needle-insertion pain and distress in children. Pediatrics, 2008, 122(Suppl 3): S130-S133.
2.	Tunç-Tuna P, Açikgoz A. The effect of preintervention preparation on pain and anxiety related to peripheral cannulation procedures in children. Pain Manag Nurs, 2015, 16(6): 846-854.
3.	Pywell A, Xyrichis A. Does topical amethocaine cream increase first-time successful cannulation in children compared with a eutectic mixture of local anaesthetics (EMLA) cream? A systematic review and meta-analysis of randomised controlled trials. Emerg Med J, 2015, 32(9): 733-737.
4.	Cozzi G, Borrometi F, Benini F, et al. First-time success with needle procedures was higher with a warm lidocaine and tetracaine patch than an eutectic mixture of lidocaine and prilocaine cream. Acta Paediatr, 2017, 106(5): 773-778.
5.	Rogers TL, Ostrow CL. The use of EMLA cream to decrease venipuncture pain in children. J Pediatr Nurs, 2004, 19(1): 33-39.
6.	Hu Y, Li Z, Mi DH, et al. Chemoradiation combined with regional hyperthermia for advanced oesophageal cancer: a systematic review and meta-analysis. J Clin Pharm Ther, 2017, 42(2): 155-164.
7.	Pour PS, Ameri GF, Kazemi M, et al. Comparison of effects of local anesthesia and two-point acupressure on the severity of venipuncture pain among hospitalized 6-12-year-old children. J Acupunct Meridian Stud, 2017, 10(3): 187-192.
8.	Lunoe MM, Drendel AL, Levas MN, et al. A randomized clinical trial of jet-injected lidocaine to reduce venipuncture pain for young children. Ann Emerg Med, 2015, 66(5): 466-474.
9.	Schmitz ML, Zempsky WT, Meyer JM. Safety and efficacy of a needle-free powder lidocaine delivery system in pediatric patients undergoing venipuncture or peripheral venous cannulation: randomized double-blind COMFORT-004 trial. Clin Ther, 2015, 37(8): 1761-1772.
10.	Brenner SM, Rupp V, Boucher J, et al. A randomized, controlled trial to evaluate topical anesthetic for 15 minutes before venipuncture in pediatrics. Am J Emerg Med, 2013, 31(1): 20-25.
11.	Kim CH, Yoon JU, Lee HJ, et al. Availability of a 5% lidocaine patch used prophylactically for venipuncture- or injection-related pain in children. J Anesth, 2012, 26(4): 552-555.
12.	Auerbach M, Tunik M, Mojica M. A randomized, double-blind controlled study of jet lidocaine compared to jet placebo for pain relief in children undergoing needle insertion in the emergency department. Acad Emerg Med, 2009, 16(5): 388-393.
13.	Singer AJ, Taira BR, Chisena EN, et al. Warm lidocaine/tetracaine patch versus placebo before pediatric intravenous cannulation: a randomized controlled trial. Ann Emerg Med, 2008, 52(1): 41-47.
14.	Zempsky WT, Bean-Lijewski J, Kauffman RE, et al. Needle-free powder lidocaine delivery system provides rapid effective analgesia for venipuncture or cannulation pain in children: randomized, double-blind comparison of venipuncture and venous cannulation pain after fast-onset needle-free powder lidocaine or placebo treatment trial. Pediatrics, 2008, 121(5): 979-987.
15.	Skarbek-Borowska S, Becker BM, Lovgren K, et al. Brief focal ultrasound with topical anesthetic decreases the pain of intravenous placement in children. Pediatr Emerg Care, 2006, 22(5): 339-345.
16.	Migdal M, Chudzynska-Pomianowska E, Vause E, et al. Rapid, needle-free delivery of lidocaine for reducing the pain of venipuncture among pediatric subjects. Pediatrics, 2005, 115(4): e393-e398.
17.	Sethna NF, Verghese ST, Hannallah RS, et al. A randomized controlled trial to evaluate S-Caine patch for reducing pain associated with vascular access in children. Anesthesiology, 2005, 102(2): 403-408.
18.	Taddio A, Soin HK, Schuh S, et al. Liposomal lidocaine to improve procedural success rates and reduce procedural pain among children: a randomized controlled trial. CMAJ, 2005, 172(13): 1691-1695.
19.	Rose JB, Galinkin JL, Jantzen EC, et al. A study of lidocaine iontophoresis for pediatric venipuncture. Anesth Analg, 2002, 94(4): 867-871.
20.	Lal MK, McClelland J, Phillips J, et al. Comparison of EMLA cream versus placebo in children receiving distraction therapy for venepuncture. Acta Paediatr, 2001, 90(2): 154-159.
21.	Lindh V, Wiklund U, Håkansson S. Assessment of the effect of EMLA during venipuncture in the newborn by analysis of heart rate variability. Pain, 2000, 86(3): 247-254.
22.	Larsson BA, Tannfeldt G, Lagercrantz H, et al. Alleviation of the pain of venepuncture in neonates. Acta Paediatr, 1998, 87(7): 774-779.
23.	Arts SE, Abu-Saad HH, Champion GD, et al. Age-related response to lidocaine-prilocaine (EMLA) emulsion and effect of music distraction on the pain of intravenous cannulation. Pediatrics, 1994, 93(5): 797-801.
24.	Manner T, Kanto J, Iisalo E, et al. Reduction of pain at venous cannulation in children with a eutectic mixture of lidocaine and prilocaine (EMLA cream): comparison with placebo cream and no local premedication. Acta Anaesthesiol Scand, 1987, 31(8): 735-739.
25.	Möller C. A lignocaine-prilocaine cream reduces venipuncture pain. Ups J Med Sci, 1985, 90(3): 293-298.
26.	Crowley MA, Storer A, Heaton K, et al. Emergency nursing resource: needle-related procedural pain in pediatric patients in the emergency department. J Emerg Nurs, 2011, 37(3): 246-251.
27.	Bice AA, Gunther M, Wyatt T. Increasing nursing treatment for pediatric procedural pain. Pain Manag Nurs, 2014, 15(1): 365-379.
28.	Abuelkheir M, Alsourani D, Al-Eyadhy A, et al. EMLA(R) cream: a pain-relieving strategy for childhood vaccination. J Int Med Res, 2014, 42(2): 329-336.
29.	Schreiber S, Ronfani L, Chiaffoni GP, et al. Does EMLA cream application interfere with the success of venipuncture or venous cannulation? A prospective multicenter observational study. Eur J Pediatr, 2013, 172(2): 265-268.
30.	Cohen LL. Behavioral approaches to anxiety and pain management for pediatric venous access. Pediatrics, 2008, 122(Suppl 3): S134-S139.
31.	Committee on Psychosocial Aspects of Child and Family Health, Task Force on Pain in Infants, Children and Adolescents. The assessment and management of acute pain in infants, children, and adolescents. Pediatrics, 2001, 108(3): 793-797.
32.	Kleiber C, Sorenson M, Whiteside K, et al. Topical anesthetics for intravenous insertion in children: a randomized equivalency study. Pediatrics, 2002, 110(4): 758-761.
33.	Zempsky WT, Robbins B, McKay K. Reduction of topical anesthetic onset time using ultrasound: a randomized controlled trial prior to venipuncture in young children. Pain Med, 2008, 9(7): 795-802.
34.	Kim DK, Choi SW, Kwak YH. The effect of SonoPrep® on EMLA® cream application for pain relief prior to intravenous cannulation. Eur J Pediatr, 2012, 171(6): 985-988.
35.	Spanos S, Booth R, Koenig H, et al. Jet Injection of 1% buffered lidocaine versus topical ELA-Max for anesthesia before peripheral intravenous catheterization in children: a randomized controlled trial. Pediatr Emerg Care, 2008, 24(8): 511-515.
36.	Jimenez N, Bradford H, Seidel KD, et al. A comparison of a needle-free injection system for local anesthesia versus EMLA for intravenous catheter insertion in the pediatric patient. Anesth Analg, 2006, 102(2): 411-414.

1. Kennedy RM, Luhmann J, Zempsky WT. Clinical implications of unmanaged needle-insertion pain and distress in children. Pediatrics, 2008, 122(Suppl 3): S130-S133.
2. Tunç-Tuna P, Açikgoz A. The effect of preintervention preparation on pain and anxiety related to peripheral cannulation procedures in children. Pain Manag Nurs, 2015, 16(6): 846-854.
3. Pywell A, Xyrichis A. Does topical amethocaine cream increase first-time successful cannulation in children compared with a eutectic mixture of local anaesthetics (EMLA) cream? A systematic review and meta-analysis of randomised controlled trials. Emerg Med J, 2015, 32(9): 733-737.
4. Cozzi G, Borrometi F, Benini F, et al. First-time success with needle procedures was higher with a warm lidocaine and tetracaine patch than an eutectic mixture of lidocaine and prilocaine cream. Acta Paediatr, 2017, 106(5): 773-778.
5. Rogers TL, Ostrow CL. The use of EMLA cream to decrease venipuncture pain in children. J Pediatr Nurs, 2004, 19(1): 33-39.
6. Hu Y, Li Z, Mi DH, et al. Chemoradiation combined with regional hyperthermia for advanced oesophageal cancer: a systematic review and meta-analysis. J Clin Pharm Ther, 2017, 42(2): 155-164.
7. Pour PS, Ameri GF, Kazemi M, et al. Comparison of effects of local anesthesia and two-point acupressure on the severity of venipuncture pain among hospitalized 6-12-year-old children. J Acupunct Meridian Stud, 2017, 10(3): 187-192.
8. Lunoe MM, Drendel AL, Levas MN, et al. A randomized clinical trial of jet-injected lidocaine to reduce venipuncture pain for young children. Ann Emerg Med, 2015, 66(5): 466-474.
9. Schmitz ML, Zempsky WT, Meyer JM. Safety and efficacy of a needle-free powder lidocaine delivery system in pediatric patients undergoing venipuncture or peripheral venous cannulation: randomized double-blind COMFORT-004 trial. Clin Ther, 2015, 37(8): 1761-1772.
10. Brenner SM, Rupp V, Boucher J, et al. A randomized, controlled trial to evaluate topical anesthetic for 15 minutes before venipuncture in pediatrics. Am J Emerg Med, 2013, 31(1): 20-25.
11. Kim CH, Yoon JU, Lee HJ, et al. Availability of a 5% lidocaine patch used prophylactically for venipuncture- or injection-related pain in children. J Anesth, 2012, 26(4): 552-555.
12. Auerbach M, Tunik M, Mojica M. A randomized, double-blind controlled study of jet lidocaine compared to jet placebo for pain relief in children undergoing needle insertion in the emergency department. Acad Emerg Med, 2009, 16(5): 388-393.
13. Singer AJ, Taira BR, Chisena EN, et al. Warm lidocaine/tetracaine patch versus placebo before pediatric intravenous cannulation: a randomized controlled trial. Ann Emerg Med, 2008, 52(1): 41-47.
14. Zempsky WT, Bean-Lijewski J, Kauffman RE, et al. Needle-free powder lidocaine delivery system provides rapid effective analgesia for venipuncture or cannulation pain in children: randomized, double-blind comparison of venipuncture and venous cannulation pain after fast-onset needle-free powder lidocaine or placebo treatment trial. Pediatrics, 2008, 121(5): 979-987.
15. Skarbek-Borowska S, Becker BM, Lovgren K, et al. Brief focal ultrasound with topical anesthetic decreases the pain of intravenous placement in children. Pediatr Emerg Care, 2006, 22(5): 339-345.
16. Migdal M, Chudzynska-Pomianowska E, Vause E, et al. Rapid, needle-free delivery of lidocaine for reducing the pain of venipuncture among pediatric subjects. Pediatrics, 2005, 115(4): e393-e398.
17. Sethna NF, Verghese ST, Hannallah RS, et al. A randomized controlled trial to evaluate S-Caine patch for reducing pain associated with vascular access in children. Anesthesiology, 2005, 102(2): 403-408.
18. Taddio A, Soin HK, Schuh S, et al. Liposomal lidocaine to improve procedural success rates and reduce procedural pain among children: a randomized controlled trial. CMAJ, 2005, 172(13): 1691-1695.
19. Rose JB, Galinkin JL, Jantzen EC, et al. A study of lidocaine iontophoresis for pediatric venipuncture. Anesth Analg, 2002, 94(4): 867-871.
20. Lal MK, McClelland J, Phillips J, et al. Comparison of EMLA cream versus placebo in children receiving distraction therapy for venepuncture. Acta Paediatr, 2001, 90(2): 154-159.
21. Lindh V, Wiklund U, Håkansson S. Assessment of the effect of EMLA during venipuncture in the newborn by analysis of heart rate variability. Pain, 2000, 86(3): 247-254.
22. Larsson BA, Tannfeldt G, Lagercrantz H, et al. Alleviation of the pain of venepuncture in neonates. Acta Paediatr, 1998, 87(7): 774-779.
23. Arts SE, Abu-Saad HH, Champion GD, et al. Age-related response to lidocaine-prilocaine (EMLA) emulsion and effect of music distraction on the pain of intravenous cannulation. Pediatrics, 1994, 93(5): 797-801.
24. Manner T, Kanto J, Iisalo E, et al. Reduction of pain at venous cannulation in children with a eutectic mixture of lidocaine and prilocaine (EMLA cream): comparison with placebo cream and no local premedication. Acta Anaesthesiol Scand, 1987, 31(8): 735-739.
25. Möller C. A lignocaine-prilocaine cream reduces venipuncture pain. Ups J Med Sci, 1985, 90(3): 293-298.
26. Crowley MA, Storer A, Heaton K, et al. Emergency nursing resource: needle-related procedural pain in pediatric patients in the emergency department. J Emerg Nurs, 2011, 37(3): 246-251.
27. Bice AA, Gunther M, Wyatt T. Increasing nursing treatment for pediatric procedural pain. Pain Manag Nurs, 2014, 15(1): 365-379.
28. Abuelkheir M, Alsourani D, Al-Eyadhy A, et al. EMLA(R) cream: a pain-relieving strategy for childhood vaccination. J Int Med Res, 2014, 42(2): 329-336.
29. Schreiber S, Ronfani L, Chiaffoni GP, et al. Does EMLA cream application interfere with the success of venipuncture or venous cannulation? A prospective multicenter observational study. Eur J Pediatr, 2013, 172(2): 265-268.
30. Cohen LL. Behavioral approaches to anxiety and pain management for pediatric venous access. Pediatrics, 2008, 122(Suppl 3): S134-S139.
31. Committee on Psychosocial Aspects of Child and Family Health, Task Force on Pain in Infants, Children and Adolescents. The assessment and management of acute pain in infants, children, and adolescents. Pediatrics, 2001, 108(3): 793-797.
32. Kleiber C, Sorenson M, Whiteside K, et al. Topical anesthetics for intravenous insertion in children: a randomized equivalency study. Pediatrics, 2002, 110(4): 758-761.
33. Zempsky WT, Robbins B, McKay K. Reduction of topical anesthetic onset time using ultrasound: a randomized controlled trial prior to venipuncture in young children. Pain Med, 2008, 9(7): 795-802.
34. Kim DK, Choi SW, Kwak YH. The effect of SonoPrep® on EMLA® cream application for pain relief prior to intravenous cannulation. Eur J Pediatr, 2012, 171(6): 985-988.
35. Spanos S, Booth R, Koenig H, et al. Jet Injection of 1% buffered lidocaine versus topical ELA-Max for anesthesia before peripheral intravenous catheterization in children: a randomized controlled trial. Pediatr Emerg Care, 2008, 24(8): 511-515.
36. Jimenez N, Bradford H, Seidel KD, et al. A comparison of a needle-free injection system for local anesthesia versus EMLA for intravenous catheter insertion in the pediatric patient. Anesth Analg, 2006, 102(2): 411-414.

West China Medical Journal

The application of noninvasive local anesthesia for venipuncture in children: a meta-analysis of randomized controlled trials

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