The effect of vapocoolant spray on pain due to intravenous cannulation in children: a randomized controlled trial

Background

Established noninvasive pharmacologic means of alleviating pain and anxiety in children undergoing intravenous cannulation are time-consuming, and thus impractical for routine use in the emergency department. Vapocoolant sprays provide transient skin anesthesia within seconds of application. We compared the effect of a new vapocoolant spray to placebo on pain due to intravenous cannulation in children.

Methods

In this double-blind randomized controlled trial, which we conducted between June 1 and Sept. 12, 2006, 80 children aged 6–12 years received either vapocoolant spray or placebo before cannulation. Children rated their pain using a 100-mm colour visual analogue scale. Secondary outcomes included success rate on first attempt at cannulation and pain ratings by the children''s parents, nurses and child life specialists.

Results

We found a modest but significant reduction in pain with the use of vapocoolant spray (mean difference 19 mm, 95% confidence interval [CI] 6–32 mm; p < 0.01). Cannulation on first attempt was more often successful with the use of vapocoolant spray (85.0%) than with placebo (62.5%) (mean difference 22.5%, 95% CI 3.2%–39.9%; p = 0.03). The number needed to treat to prevent 1 cannulation failure was 5 (95% CI 3–32). Parents (p = 0.04), nurses (p = 0.01) and child life specialists (p < 0.01) considered the children''s pain to be reduced with the use of vapocoolant spray.

Interpretation

The vapocoolant spray in our study quickly and effectively reduced pain due to intravenous cannulation in children and improved the success rate of cannulation. It is an important option to reduce childhood procedural pain in emergency situations, especially when time precludes traditional interventions.(http://ClinicalTrials.gov trial register no. {"type":"clinical-trial","attrs":{"text":"NCT00130650","term_id":"NCT00130650"}}NCT00130650.)Children frequently undergo intravenous cannulation in the emergency department. This painful procedure causes considerable stress and anxiety for children and their parents.¹ Failure to alleviate pain results in an uncooperative child, unsuccessful procedures (increased reattempts), prolonged procedure time and dissatisfaction with care for all involved.² Although pain may be reduced by behavioural and pharmacologic interventions (e.g., age-appropriate patient preparation, parental presence, distraction techniques, subcutaneous local anesthetics, topical anesthetic and systemic anesthetics), most of these preparations are impractical in nonelective settings because they are too time-consuming.^3–12 Novel delivery approaches and new medication compositions may decrease this time.^13,14 Vapocoolant sprays are rapid-acting alternatives to topical anesthetics. They provide transient anesthesia via evaporation-induced skin cooling, which reduces pain. Results from studies of earlier vapocoolant sprays indicated that they reduced pain due to vaccine injection in children and adults,^15–18 but not pain due to intravenous cannulation in children.^19,20 We sought to determine whether a new product, Pain Ease (Gebauer Company, Cleveland, Ohio), would reduce pain with intravenous cannulation in children.